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Full text of "United States Navy Medical News Letter Vol. 44 No. 8, 23 October 1964"

Vol. 44 



Friday, 23 October 1964 



No. 8 



'''/ i964 




-^1 



^ 



MADIGAN GI^HERAl HOSPITAL 



CONTENTS 



AVIATION MEDICINE 

U.S. Naval Aviation Medical 

Center — Pensacola, Fla. 

Specialized Training in Aviation Medicine 

Certification in Aviation Medicine 

MSC Aviation Physiology Program 

Aviation Physical Qualifications 

Training in Aviation Operational Psychology 

Of the Flight Surgeon's Function 

Aviation Safety 

Transport Sets First in Mercy Mission 

ORIGINAL ARTICLES 

Some Responsibilities of the Navy Pharmacist in 

Quality Control of Drugs 

Pathogenesis and Treatment of Urinary Infection _ 

MEDICAL ABSTRACTS 



DENTAL SECTIO:^" " 



■.'s. ARMY 



1 

4 

5 

6 

7 

9 

10 

10 

10 



11 
13 



Relining Dentures with Silicone Rubber 

Use of Anorganic Bone in Dentistry 

Organic Factors in Calculus Deposition 

Dental Health Status of Children Five Years 

After School Care Programs 

Professional Notes 

FROM THE NOTE BOOK 



Indoctrination Courses for Medical Officers 

Technician Training Available 

BUMED INST. 6230. IIC 

Army Postgraduate Courses for 

Medical Department Officers 

MISCELLANY 



FROSTBITE (Part II) 16 Officer Preference and Personal Information Card — 



20 
20 
21 

21 
21 



23 
23 

23 

25 



26 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 44 



Friday, 23 October 1964 



No. 8 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor ~ '«".; 

William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W, Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 

addresses. 



FRONT COVER: Photograph of architects' sketch for the new buildings and landscaping of the U. S. Naval 
School of Aviation Medicine, one of the three Component Commands of the U.S. Naval Aviation Medical Center, 
Pensacola, Florida. Construction work is well-advanced and it is anticipated that occupancy and commissioning 
ceremonies will take place in January 1965. Plans and construction are under the cognizance of Department of 
the Navy, Southeast Division — Bureau of Yards and Docks, U.S. Naval Base, Charleston, South Carolina. Hugh 
J. Leitch and Moreland Griffith Smith of the firm of Sherlock, Smith and Adams, Architects-Engineers, 2925 Navy 
Blvd., Pensacola, Florida, (Official U.S. Navy Photograph, Photographic Laboratory, Naval Air Station, Pensa- 
cola, Florida) Editor 



The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



1 



WOV 2 



1364 



AVIATION MEDICINE SECTION 




SPECIAL FEATURE 
U. S. Naval Aviation Medical Center, Pensacola, Florida 



The U.S. Naval Aviation Medical Center, located 
aboard the Pensacola, Fla. Naval Air Station, contrib- 
utes a major portion of the Navy's medical program of 
adapting man to flight. 

It was established on 8 April 1957 by authority of 
the Secretary of the Navy and commissioned on 30 
April 1957 by Rear Admiral B. W. Hogan MC, then 
Surgeon General of the Navy. 

Occupying a little over 39 acres of land, the Center 
is comprised of the U.S. Naval Hospital, U.S Naval 
School of Aviation Medicine, and U.S. Naval Aviation 
Medical Center Staff Unit. 

Rear Admiral Langdon C. Newman MC, is the 
fourth Commanding Officer and the second officer of 
flag rank to command the Center. 

Through joint utilization of the professional staff of 
the U.S. Naval Hospital and the U.S. Naval School of 
Aviation Medicine, consultation and diagnostic serv- 
ices are available to all military activities in the Gulf 
Coast area — from Panama City, Fla, to New Orleans, 
La. and north to Atlanta, Ga. 

A clinical aspect of the Center is the special board 
of flight surgeons, composed of top medical specialists 
who convene each week to evaluate all "problem cases" 
arising throughout Naval and Marine Corps aviation. 

The U.S. Naval Hospital, though not one of the 
largest, is considered to be one of the Navy's finest. 
It has been approved by the Bureau of Medicine and 
Surgery to conduct 12 months rotating internship pro- 
grams and is accredited by the Joint Commision on 
Accreditation of Hospitals of the United States and 
Canada. 

U.S. NAVY MEDICAL NEWS LETTER 




RADM LANGDON C. NEWMAN 

Official U.S. Navy Photograph, Photographic 

Laboratory, NAS, Pensacola, Florida. 



,.,..,., -EMER/\i: HOSPITAL 
PROrZRTf OF U.S. ARMt 




U. S. NAVAL HOSPITAL— PENSACOLA, FLA. 

Official U.S. Navy Photograph, Photographic Laboratory, NAS, Pensacola, Florida. 



Under the command of Captain Merrill H. Good- 
win MC, the Hospital is situated in the southwestern 
section of the Naval Air Station overlooking Pensacola 
Bay and the Gulf of Mexico. 

It is reported that Pensacola is the site of the first 
U.S. Naval Hospital. The present structure, dating 
from 1941, houses the fifth in a series of Hospitals in 
Pensacola. The Hospital, equipped with 428 operat- 
ing beds and 15 bassinets, has a staff of 100 officers, 
170 enlisted personnel and 101 civilian employees. 

The modern facilities and top medical experts at the 
Naval Hospital are augmented by 24 prominent civilian 
consultants in medical specialties from Pensacola and 
Mobile, Ala. 

On the staflf are medical and dental officers with spe- 
cialized training in the fields of general surgery, 
orthopedic surgery, internal medicine and cardiology, 
obstetrics and gynecology, pediatrics, radiology, pa- 
thology, neuropsychiatry, dermatology, urology, otorhin- 
ology, ophthalmology, and oral surgery. 

In keeping with the modern trends in hospital man- 
agement, the Naval Hospital currently employs a 
variety of nevv techniques ranging from the use of a 



selective menu system for feeding patients to the use 
of a recovery room for the post-operative care of 
surgical patients. 

The scope is indeed wide and continues to grow and 
adjust to the modern procedures which are recom- 
mended and accepted in the better circles of modern 
medicine. It ofi:ers excellent medical care for military 
personnel and their dependents arount the clock, year 
'round. 

The U.S. Naval School of Aviation Medicine, under 
the command of Captain Henry C. Hunley, Jr. MC, 
has a dual mission — that of training aviation medical 
department personnel and conducting aerospace medical 
research. 

Officer training programs include: a six-month 
training program for medical officers leading to desig- 
nation as naval flight surgeons; two-year residency 
program in aviation medicine leading to board certifica- 
tion in Preventive Medicine (Aviation Medicine); 
a six-month training program for experimental psychol- 
ogist; a four-month training program for aviation 
physiologists; and refresher courses for naval flight 
surgeons. 



U.S. NAVY MEDICAL NEWS LETTER 




CAPT. MERRILL H. GOODWIN 

Official t/.S, Navy Photograph, Photographic 
Laboratory, NAS, Pensacola, Florida. 



CAPT HENRY C. HUNLEY, JR. 

Official U.S. Navy Photograph, Photographic 
Laboratory, NAS, Pensacola, Florida. 



Enlisted training programs include conducting schools 

in aviation medicine and aviation physiology technique. 

The School of Aviation Medicine supports the Naval 

Air Training Command in the psychological testing 

and selection of personnel. 

Physiological indoctrination and instruction of non- 
medical aviation personnel in high altitude, night vi- 
sion, emergency escape procedures and other related 
fields are also provided. 

Examining facilities and highly qualified senior naval 
flight surgeons are available at the School to determine 
the physical fitness of personnel for admission to and 
retention in the Naval Aviation Training Program. 

Research in aviation medicine preceded the official 
establishment of the Naval School of Aviation Medi- 
cine. 

Although the major research activities of the School 
are still in the field of aviation medicine, the research 
staff has reoriented much of their program in order to 
undertake investigations relevant to bioastronautics. 

These studies include cosmic radiation, exotic en- 
vironments, bizarre accelerations, animal and human 
space flight, selection of astronauts and medical aspects 
of recovery of astronauts. 

As early as the summer of 1940, a group of scientists, 
sponsored by the Bureau of Medicine and Surgery and 



the National Research Council, conducted clinical 
studies and various physiological and psychological 
tests on 1,056 student aviators and flight instructors. 
This longitudinal study of normal individuals has been 
followed at intervals ever since and is referred to as 
the "1,000 Aviator Program." 

The School of Aviation Medicine will move into its 
new facilities in January 1965. 

These newly constructed facilities will consist of 
two windowless, air-conditioned buildings with a com- 
bined total area of 90,000 square feet (see front cover 
of this issue of Medical News Letter). 

The main building is a two-story structure, with an 
animal penthouse, providing spaces for administration 
and research. 

The second building will provide classroom facilities 
for the training of student flight surgeons and modern 
facilities for the aviation physical examination division. 

The recently dedicated Vestibular Laboratory houses 
not only the Slow Rotation Room and a Human Dis- 
orientation Device, but a newly constructed Coriolis 
Acceleration Platform. 

This and the Vestibular Laboratory annex, which will 
house a horizontal linear oscillator, an animal centri- 
fuge, and a visual display screen, will continue to be 
one of the Command's major research facilities. 



U.S. NAVY MEDICAL NEWS LETTER 




CAPT FRANCIS L. WESTBROOK 

Official U.S. Navy Photograph, Photographic 
Laboratory, NAS, Pensacola, Florida. 



The newest addition to the Center is the U.S. Naval 
Aviation Medical Center Staff Unit, coitimanded by 
Captain Francis L. Westbrook, MSC. This unit was 
established on 22 April 1963 to provide administrative 
support to the commanding officer of the Naval Avia- 
tion Medical Center and members of his staff. This is 
accomplished by performing routine functions of com- 
mand in the administration and discipline of enlisted 
personnel assigned to the staff of Admiral Newman. 



Specialized Training in Aviation Medicine 



A limited number of medical officers each year are 
afforded the opportunity for specialized training in 
aviation medicine. 

Medical officers selected for such training are sent to 
the U.S. Naval School of Aviation Medicine at the 
Naval Aviation Medical Center, Pensacola, Florida, 
for a course of instruction lasting about six months, 
and, upon successful completion of the course, they are 
designated naval flight surgeons. 

The curriculum is divided into two parts. The first, 
approximately four months, is a good general review of 
all medical subjects, with emphasis placed on a few 
subjects which are more important in aviation medi- 
cine, i.e., ophthalmology, otolaryngology, psychiatry, 
cardiology, and physiology — both respiratory and cardi- 
ovascular. The second phase, approximately two 
months, is devoted to flight training. This training 
should qualify one to solo aircraft, although flight sur- 
geons and student flight surgeons will not be required 
to do so. Medical officers designated as flight surgeons 
and ordered to duty involving flying are entitled to 
additional pay while so serving. 

Duty assignments of flight surgeons are to naval air 
stations, to various type squadrons — both Navy and 
Marine — to aircraft carriers, etc. Station hospitals on 



major naval air stations provide professional opportu- 
nities in all respects similar to those in smaller navai 
hospitals. In addition, there is opportunity for con- 
siderable research in aviation medicine, dealing with 
such problems as selection and training of pilots, dis- 
orientation, "g" forces, oxygen supply, protective equip- 
ment, escape from high speed, high flying aircraft, etc. 

All medical officers, whether regular or reserve, are 
required to sign a "service agreement" before being 
ordered to any duty under instruction. Therefore, 
should you desire to apply for duty under instruction in 
aviation medicine, you should include the following 
statement: "If my request is approved, I agree to re 
main on active duty for one year beyond the comple- 
tion of th6 course, or for six months beyond my cur- 
rent obligated service, whichever is longer." This 
agreement normally extends an officer's active duty 
status by the length of the course, or a period of six 
months. 

Your request should be addressed to the Chief, Bu- 
reau of Medicine and Surgery, Department of the 
Navy, Washington, D.C. 20390, with the subject: 
"Course of instruction in aviation medicine; request 
for." Include the service agreement as stated above. 
Classes convene each January, July, and October. 



U.S. NAVY MEDICAL NEWS LETTER 



Certification in Aviation Medicine 



Reqirements of the American Board of Preventive 
Medicine for Certification In Aviation Medicine are: 

1. Preventive Medicine and Public Health — 1 aca- 
demic year. 

2. Residency In Aviation Medicine — 2 years. 

a. Approved and supervised clinical and field 
practice or research. 

3. Practice of Aviation Medicine — 3 years. 

a. Approved clinical and field practice, research, 
or training. 

U. S. NAVY PLAN 

1 . Academic schooling 

a. School of Aviation Medicine to designation 
as Naval Flight Surgeon — 6 months. 

b. Preventive Medicine and Public Health, civil- 
ian university — 1 academic year. 

2. Residency in Aviation Medicine 

a. Rotating residency — School of Aviation Medi- 
cine — 24 months. 

3. Practice in Aviation Medicine 

a. Approved field and fleet practice — 30 months. 

OUTLINE OF THE NAVY SIX YEAR PLAN 

1. Academic Schooling 

The first phase is the basic regular course leading to 
the designation of Naval Flight Surgeon. This course, 
of six months' duration, is conducted at the Naval 
School of Aviation Medicine, Pensacola, Florida, and 
classes convene thrice each year. The course familiar- 
izes the student with the application of the clinical 
specialities to aviation medicine, the aerospace equip- 
ment utilized, and actual flight training. Those students 
who are physically qualified and successfully complete 
the flight syllabus are permitted to solo. 
XL Practice in Aviation Medicine 

The second phase is one of 24 months or more of 
general Aviation Medicine practice. Prospective can- 
didates for the Boards would have the privilege of 
requesting billets that would offer the required oppor- 
tunities. In general, the majority of the billets to be 



filled by men at this level of training would be opera- 
tional billets with the fleet and with the Marines. 

III. Postgraduate Training 

The third phase is one of an approved graduate 
course in Preventive Medicine at an acceptable civilian 
university leading to the degree of Master in Public 
Health. It shall consist of an academic year of school- 
ing in the principles and practices of preventive medi- 
cine. 

IV. Residency Training Period 

The fourth phase shall be one of 24 months under 
direct supervision of the School of Aviation Medicine. 
It is believed that in this phase, recognition of indi- 
vidual preferences should be taken. From experience 
it is proposed to recognize this variation by allowing 
special research on a project of their choice during the 
program. The training is a mixed type with rotation 
through the departments of ophthalmology, otolaryn- 
gology, neuropsychiatry, cardiology, aviation physiol- 
ogy, and work at a U.S. naval hospital on various medi- 
cal and surgical services. Field trips to the Naval 
Aviation Safety Center, Armed Forces Institute of 
Pathology, Aerospace Crew Equipment Laboratory, 
and the Aviation Medical Acceleration Laboratory are 
scheduled during the residency. Upon completion of 
this phase, and provided a total of six years have 
elapsed since commencement of the first phase, the in- 
dividual is eligible for examination by the American 
Board of Preventive Medicine in Aviation Medicine. 

Application 

Applications for residency training in aviation medi- 
cine should be made by means of an official letter, ad- 
dressed to the Chief of the Bureau of Medicine and 
Surgery, and forwarded via the chain of command. 
Applications must be submitted in time to reach the 
Bureau by 15 August of the year preceding commence- 
ment of desired training. The BUMED Professional 
Advisory Board will consider the initial application for 
residency training as being an application for the entire 
period required to become Board eligible in the spe- 
cialty. For further details, applicants are referred to 
BUMED Instruction 1520. IOC. 



More than 75% of human cancers are potentially preventable, either by the removal of control of the causative 
factors or by the treatment of precancerous conditions. — WHO Chronicle 18(9): 323, September 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



MSC Aviation Physiology Program 



The Aviation Physiology Program of the Navy Med- 
ical Service Corps is administered by the Aviation 
Medicine Division of the Bureau of Medicine and 
Surgery. Jts members share an important role in the 
Navy Medical Department's vast program of training 
naval aviators and aircrewmen to cope with the hazards 
of flight which may be encountered in the use of high 
performance naval aircraft. Unlimited opportunities 
exist for professionally qualified individuals who are 
interested in the various aspects of aerospace medicine. 
Aviation physiologists are assigned to major naval 
aviation activities where duties consist of providing in- 
struction in the physiological aspects of the high alti- 
tude environment, oxygen breathing equipment, cabin 
pressurization, personal airborne protective equipment, 
night vision techniques, use of the ejection seat, and 
fitting and operation of space suits. Physiological 
training devices, such as the low pressure chamber, the 
ejection seat trainer, and the night vision trainer, are 
operated under the supervision of the aviation physiol- 
ogist. Officers whose duties require their exposure to 
simulated high altitudes in low pressure chambers may 
be paid special hazardous duty pay of an additional 
$110 per month. 

Physiologists in training assignments who meet or 
acquire the educational requirements and demonstrate 
a capacity for research may move into the research 
program or develop a balanced career pattern of re- 
search and training. There are assignments combining 
in varying degrees research, test, and evaluation with 
training. 

Aviation Physiology is only one of a number of 
specialties in the Medical Allied Sciences Section of 
the Medical Service Corps and constitutes a relatively 
small segment of the total Corps. While it is, of 
necessity, a very highly select group, there are a few 
vacancies available each year for qualified people to 
come on active duty and participate in the program. 
Applications are desired particularly from individuals 
who have received a Ph.D. degree or will receive the 
degree prior to actual appointment in the Navy. Such 
individuals are commissioned in the Naval Reserve as 
Lieutenants (Junior grade) with eighteen months prece- 
dence is rank. Applications are solicited from those 
who possess a Master's degree with advanced academic 
training in physiology. Such individuals are com- 



missioned in the Naval Reserve as Ensigns with a 
current date of rank. Applications are also desired 
from individuals who hold a baccalaureate degree from 
an accredited college or university with a major in 
biology, physics, or chemistry who will receive the de- 
gree prior to appointment in the Navy. Selected can- 
didates in the latter category will be commissioned 
Ensign in the Naval Reserve upon completion of the 
Aviation Officer Candidate School at the Naval Air 
Station, Pensacola, Florida. Aviation physiologists in- 
terested in a career in the Navy Medical Department 
may, under present regulations, apply for augmentation 
into the Regular Navy after a prescribed period of ac- 
tive duty in the Naval Reserve. 

In addition to the opportunity to serve their country 
in their chosen profession, the Navy Medical Depart- 
ment also provides members . of the Medical Service 
Corps certain financial assistance in the pursuit of fur- 
ther graduate education, work shops and seminars. 
Consultative and statistical assistance is available to 
those desiring to accomplish individual research endeav- 
ors, and officers are encouraged to participate in both 
regional and national professional meetings. 

On 18 September 1964 there were thirty (30) Avia- 
tion Physiologists on board, I Captain, 6 Commanders, 
6 Lieutenant Commanders, 6 Lieutenants, 6 Lieu- 
tenants, Junior Grade, 4 Ensigns and 1 Warrant Officer. 
Of this number, twenty-one (21) were U.S. Navy, 9 
were U.S. Naval Reserve. 

One (1) was assigned to the Bureau of Medicine and 
Surgery as Head, Aviation Medicine Equipment 
Branch, with additional duty at the Bureau of Naval 
Weapons; nineteen (19) were serving in training assign- 
ments; nine (9) were assigned to laboratories where 
research, development and evaluation studies are car- 
ried out in addition to training. Of this latter number, 
one (I) was assigned to the Bureau of Medicine and 
Surgery on additional duty to the Aviation Medicine 
Training Branch; one (1) was assigned to the Bureau 
of Medicine and Surgery on additional duty to the 
Aviation Medicine Equipment Branch, and to the 
Bureau of Naval Weapons. One (1) was attending 
George Washington University on a full time basis. 
One (1) officer candidate was under instruction at the 
U. S. Naval School Pre-flight, U. S. Naval Air Station, 
Pensacola, Florida. 



U.S. NAVY MEDICAL NEWS LETTER 



Application procedures are conducted through the 

Navy Recruiting Stations, and the one nearest your 
home can assist you in the initiation of an appUcation 
for appointment and commission in the Medical Service 
Corps, U. S. Naval Reserve, as aviation physiologist. 



If additional information is desired, please feel free to 
address inquiries to the Director, Medical Service Corps 
Division, Bureau of Medicine and Surgery, Department 
of the Navy, Washington, D.C., 20390, 



Rambling with Aviation Physical Qualifications (Code 511) 

By CDR N. D. Sanborn, MC USN, Head of Aviation Physical Qualifications Branch 
(Code 511), BUMED. 



Communication is an essential ingredient of team 
work. The selection and retention of individuals pos- 
sessing the physical qualifications required of aviation 
personnel in the Navy are the prime roles of the naval 
flight surgeon in this branch of the Bureau of Medicine 
and Surgery. With safety as a guiding light, efficient 
and effective compliance with these roles requires team 
work of the first order. The communication between 
the field and this Bureau, therefore, should correspond- 
ingly be of prime importance and magnitude. 

With this initial endeavor, Aviation Physical Qualifi- 
cations (BUMED Code 511) plans to periodically 
submit articles pertaining primarily to physical quali- 
fications, but will also include other aspects associated 
with the specialized practice of aviation medicine. In 
order for these articles to be more meaningful, cor- 
respondence from the field will be welcomed and is 
encouraged. Code 511 is interested in constructive 
criticism of existing qualifications, problem areas in 
specific aviation personnel, experiences that might prove 
helpful to others and inquiries concerning specific or 
general aspects of physical qualifications of aviation 
medicine for which an answer, an explanation or addi- 
tional information is desired. The exchange of ideas 
and information between the Bureau and the field 
should be helpful to both and foster improved team 
work potentialities. 

ADVANCE INFORMATION 

1. An advance change to the Manual of the Medical 
Department has recently been submitted and should be 
published in the near future. This changs has re- 
sulted in many revisions in Section V Aviation, articles 
15-59 through 15-73. Some revisions of note are as 
follows: 

a. Inclusion of BUMED Instructions 61 10.4 through 
6110.7. 



b. Revision of weight standards for the NAG (H) 
formally ( 1 ) or (B/H) to conform with the same stand- 
ards as for the naval aviator. The stature height and 
sitting height were retained. 

c. NAO (H) applicants — visual acuity standards 
raised to 20/40 or better. 

d. NAO (L) applicants— visual acuity standards 
raised to 20/100. 

e. Aircrewmen — depth perception not required. 

f. A requirement to insure that a baseline ECG is 
a permanent component of the health records of all 
Class 1 aviation personnel. 

g. A requirement to insure that all aviation personnel 
are grounded when admitted to a hospital or otherwise 
placed on the sick list, and will remain grounded until 
they have undergone such aviation physical examina- 
tion as deemed necessary by the flight surgeon, and a 
Flight Clearance Certificate (NAVMED Form 1381) 
has been submitted as prescribed. 

h. The requirement and instructions for tonometric 
measurement of intraocular pressure have been added. 

Constructive criticism of the Manual change, when 
published, as to discrepancies, inconsistencies and rec- 
ommendations would be greatly appreciated. 
2. A new BUMED Instruction (proposed 6110.8) con- 
cerning anthropometric measurements and classification 
of all aviation personnel is nearing its final stage of 
clearance and will be distributed in the near future. 

a. Personnel in the joint SUPERS and BUWEPS 
endeavor concerning human factors in weapons sys- 
tems desire the classification of all aviation personnel on 
the basis of stature height and sitting height. 

b. Blueprints for the anthropometric measuring de- 
vice and instructions will be forwarded to all activities 
conducting aviation physicals. The device will be 
constructed locally, using local funds. 



U.S. NAVY MEDICAL NEWS LETTER 



c. Categorization of naval aviators using the height 
and sitting height classification code will allow revi- 
sion of the present height standards for entry into flight 
training (will not apply to U. S. Marine student naval 
aviators). The new height standards will read — not 
less than 64 inches and not more than 78 inches, pro- 
viding the sitting height is not less than 32 inches or 
more than 41 inches and the buttock-leg length is not 
less than 36 inches or more than 50 inches. 

WHIPPING POST 

Code 5 1 1 clears and takes action on an average of 
1264 health records, a week. Of these, an average of 
172 or over 10 % must be returned to the examining 
activity because of an incomplete record, either due to 
an omission, a disqualifying entry, or need for addi- 
tional information before a recommendation can be 
made to SUPERS or MARCORPS. 

Know the competency of your own team. It would 
be physically impossible for the flight surgeon to con- 
duct every aspect of a complete flight physical. How- 
ever, since the flight surgeon signs the SF 88, he attests 
to the reliability and accuracy of everything that has 
been recorded. The flight surgeon must closely super- 
vise, review performances and instruct in order to 
guarantee accuracy of the recorded findings. 

Possibly the most important function of the flight 
surgeon, in regards to a flight physical, is a conscien- 
tious and thorough review of all entries on the finished 
SF 88 prior to affixing his signature. This is the time 
to verify the findings the flight surgeon wants recorded 
and to be certain that the recommendations to BUMED 
are accurately stated and that the completed form is 
free of omissions, contradictions, and typographical 
errors. A little additional time at this point might very 
well save the flight surgeon, the Navy, and the examinee 
embarrassment, may prevent delay in obtaining action 
and can save the time that otherwise would be in- 
volved, to say nothing of the monetary implications. 

An example which recently came to the attention of 
this Code: A candidate arrived at Pensacola to enter 
flight training as a student naval aviator. However, 
on the entry to pre-flight physical examination (that 
every candidate receives in Pensacola) the candidate 
was found to be color blind. On questioning, the ex- 
aminee related the following: On his initial examination 
a corpsman asked him if he was color blind. The 
candidate really not knowing, but wanting nothing to 
interfere with his acceptance, answered "no". The 
corpsman recorded in item #64 — Passed Falant. Two 
months later on his active duty physical the findings in 
#64 were transcribed to the new form and again the 
candidate was not tested. Testing at Pensacola brought 
forth the truth and the candidate was found not quali- 
fied for any flight program or for appointment to a 
commissioned grade. He was naturally bitter and 

8 



resentful on being returned home, after giving up a 
job to enter the Navy. The Navy is embarassed, .re- 
ceives bad publicity and suffers a monetary loss of not 
having a future pilot and the expense of transferring 
the individual from home, to Pensacola and back. 

This Bureau can only go on what the field submits 
and in many cases this represents the only contact it 
has with the individual flight surgeons. Thus an indi- 
vidual flight surgeon can be known by what he signs 
which, in essence, can indicate his leadership, knowl- 
edge and conscientious performance of his duties. 

QUERIES AND ANSWERS 

1. I have submitted SF 88 and 89, for record purposes 
only, on individuals found not qualified for flight train- 
ing only to receive a request for additional information 
that has no bearing on the disqualifying defect. WHY? 
Answer: Code 511 must work closely with the Physi- 
cal Qualifications and Medical Records Division of 
BUMED (Code 33) which alone has the power of find- 
ing an individual qualified for appointment to a 
commissioned rank. Code 51 1 must wait for the com- 
missioning section's action before it can make a recom- 
mendation as to the qualifications for entry into duty 
involving flying. In order to avoid delay, the appoint- 
ment section first reviews the health record and makes 
its recommendation or indicates what additional infor- 
mation is necessary to effect action. The record is then 
sent to Code 51 ! where it is first reviewed to verify if 
AQT and FAR test scores are available and the results. 
Then the record is reviewed to see if all the informa- 
tion necessary to make a recommendation concerning 
duty involving flying is available. Code 511 initiates 
all additional information letters to the examining 
activities on all aviation personnel or candidates. Even 
though we agree an individual does not qualify for any 
aviation program, the Navy and therefore the com- 
missioning section is interested in the individual qualifi- 
cations for appointment and duty in other than aviation 
programs. Therefore in order to work jointly on all 
applications, rather than individually. Code 511 must 
request any information desired by the commissioning 
section. 

2. Why the difference in weight standards for the 
NAO (I) and aviators since they ride side by side in 
the same plane? 

Answer: Not all pilots fly in aircraft in which the full 
pressure suit must be worn. The NAO (I) must ful- 
fill this requirement. The requirements for the NAO 
(1) were agreed upon after joint meeting with all 
concerned. The revised change to the Manual of the 
Medical Department standardized the NAO (I) weight ' 
to correspond with that of the naval aviator. This 
Code feels the present weight standards are physiologi- 
cally unsound and hopes to revise them in the near 
future. To Emphasize: Code 511 encourages and 

U.S. NAVY MEDICAL NEWS LETTER 



will welcome correspondence from the field in regards 
to Physical Qualifications in aviation medicine. Com- 



ments as to the desire for further related articles and 
constructive criticism will also be greatly appreciated. 



Specialized Training in Aviation Operational Psychology 



The Medical Service Corps offers unique and reward- 
ing careers to officers qualified In any of several facets 
of experimental psychology. Originally oriented to, 
and still primarily concerned with, aerospace psychol- 
ogy, specialized training and professional practice are 
offered in virtually all aspects of behavioral study, in- 
cluding learning, human factors engineering, systems 
analysis, methodology and criterion research, industrial, 
engineering and mathematical psychology. 

The first stage of this program for all qualified psy- 
chologists is a six-months course at the U. S. Naval 
School of Aviation Medicine, Pensacola, Florida. This 
course is sufficiently flexible to be adaptive to indi- 
viduals with different educational backgrounds and 
professional experience, but maintains a reasonable 
constancy in the basic content. The course includes; 

1 . Naval orientation and philosophy. 

2. Research problems and methods in the naval en- 
vironment. 

3. Research project planning. 

4. Human factors research in Navy laboratories. 

5. Flight safety and survival training. 

6. Pre-flight and basic flight instruction, 

7. Carrier operations. 

8. On-the-job training in experimental psychology. 
Duty assignments for junior officers are usually to 

research laboratories. Specific assignments are deter- 



mined by the experience and research interests of the 
Individual officers within the constraints of billet avail- 
ability. Officers who have not completed doctoral 
training have the opportunity to apply for transfer to 
the regular Navy after eighteen months of active duty, 
and may then be assigned to Duty Under Instruction 
at the college or university of choice (provided the level 
of training required by the Navy is offered) for as 
much as two years to complete class work, examina- 
tions, language requirements, and at least collect data 
for doctoral dissertation. 

In addition to the laboratory billets, there are a num- 
ber of staff and field billets which offer a rather wide 
variety of professional experience. There are staff 
billets in the Bureau of Naval Weapons, the Office of 
Naval Material, Naval Operations and Naval Research. 
Field billets include the Naval Air Advanced Training 
Command, and anti-submarine warfare activities in 
both the Atlantic Fleet and Pacific Fleet. 

There are twenty-nine experimental psychologists on 
active duty, three of whom are engaged in graduate 
work. There are currently five unoccupied research 
billets for which qualified officers are needed, either 
newly commissioned or as transfers from the Line. 

Inquiries concerning the Experimental Psychology 
program should be addressed to the Chief, Bureau of 
Medicine and Surgery (Cade 513), Department of the 
Navy, Washington, D. C. 20390. 



INDO-NEPAL BORDER ANTIMALARIA CONFERENCE 

The third Indo-Nepal Border Antimalaria Conference 
was held on 5 and 6 June 1964 in Darjeeling, India. 
These meetings, arranged by the governments concerned 
in association with WHO, consider the coordination of 
malaria eradication work in the inter-country border 
regions. Technical matters of mutual interest to the 
programmes concerned are also discussed. In addition 
to representatives from the participating countries, the 
meetings are attended by participants from WHO and 
the U. S. Agency for International Development. The 
previous meeting was held in Kathmandu, Nepal, from 
14 to 16 February 1963.— WHO Chronicle 1S(9) : 358, 
September 1964. 



HELP FOR BOLIVIA AGAINST FOOT AND 
MOUTH DISEASE 

The Government of Bolivia, with the help of the Pan 
American Sanitary Bureau, which acts as the WHO 
Regional Office for the Americas, is to undertake a 
two-year campaign against fool and mouth disease dur- 
ing which 20,000 cattle will be vaccinated in the coun- 
try's main agricultural region — the 23,000-square-mile 
Cochabamba Province, 

A new, weakened live virus vaccine will be used. It 
has been developed by the Pan American Foot and 
Mouth Disease Center in Brazil, and is intended to give 
much longer protection than the vaccine in present use. 
—WHO Chronicle 18(9): 357, September 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



Of the Flight Surgeon's Function 



From: Personnel of the Royal Air Force Investigated During the War, 1939-1945, 
published by The Air Ministry, Air Publication 3139. 



Station and squadron commanders were emphatic 
that medical officers should be carefully chosen for this 
work, and they agreed very closely upon the most suita- 
ble type of man for it. They preferred a man with 
fairly wide experience, not one newly qualified. His 
age should be around 30 years, and he should be ma- 
ture and have sufficient savoir faire for the crews to 
come along with their domestic and social troubles. 
Sometimes a younger man is able to fill this role, and 
then he has the advantage that he is more likely to play 
games and enter into a party. Above all, the squadron 
medical officer must be a good mixer. It is easier for 
him if he is not teetotal, but though he should drink 
with the crews, he should always be a little behind 
them and should not be the life and soul of the party, 
in case he should lose their respect. He must be a 
practical man who can cope with an emergency, so that 
he always has the crews' confidence, but for this, he 
need not be a good academic physician. In order to 
maintain their confidence, he must always be available 
when emergencies arise. He should invariably be pres- 
ent at briefing, take-off, return and interrogation, and 
should mix freely in the crew rooms. High praise is. 



"Wherever there is flying, the doc is there." This en- 
tails living in the station and taking recreation with 
the squadron in the crew rooms, the hangars, in the 
air, the messes and outside parties. Although liaison 
between the medical officer and the commanding offi- 
cers should be as intimate as possible, it should be 
outside the knowledge of the crews. 

The crews should look on the medical officer, not 
only as one of themselves, but as their doctor. They 
will bring their small complaints to him, and they will 
expect him to be available in times of disaster. When 
they bring their anxieties and fears to .him, or when 
by word or sign he sees evidence of deterioration, he 
should act promptly, for "decision and acceptance of 
responsibility in these cases is the medical officer's 
supreme task." The men will make confidences to the 
medical officer that they would hide from others, and 
some will even go to a medical officer knowing that he 
wili discuss the problem with the squadron commander, 
rather than go to the squadron commander himself. In 
this way, the medical officer obtains a unique position 
in the squadron, and if he uses it properly, can have a 
great influence upon squadron morale. 



AVIATION SAFETY 

During Fiscal Year 1964, the aircraft accident rate 
(number of accidents per 10,000 flight hours) declined 
to 1.35, an 8.1 percent improvement over the preceding 
year and the safest in Naval Aviation history. The 
fatality rate declined 16 percent over the previous year. 
There were 500 aircraft accidents, resulting in the loss 
of 287 aircraft and 199 lives. Aircraft carrier landing 
accidents also declined in spite of an increase of nearly 
29,000 landings made over 1963. 

The Admiral Flatley Memorial Award, presented an- 
nualy to the leading ships of their type in accident pre- 
vention during aircraft carrier operations, was awarded 
to the USS FRANKLIN D. ROOSEVELT (CVA 42), 
the USS INTREPID (CVS 11), and the USS IWO 
JIMA (LPH 2), 



TRANSPORT SETS FIRST IN 
MERCY MISSION 

An LC-130F Hercules, commanded by Lieutenant 
Robert V, Mayer, of Air Development Squadron SIX 
(VX-6), completed a round-trip flight from Christ- 
church, New Zealand, to Antarctica on 26 June in an 
emergency evacuation of B. L. McMu'.len, builder first 
class, who was critically injured in a fall. Two planes, 
with teams of medical specialists on board, flew from 
NAS Quonset Point to Christchurch where one plane 
stood by while the other made the hazardous flight. It 
was the first midwinter landing in history on the Ant- 
arctic Continent. 

The above two items from: USN "Recent Achieve- 
ments of the Navy", Office of the Chief of Naval Op- 
erations, Washington, D. C, I May 1964 to 31 July 
1964, 



10 



U.S. NAVY MEDICAL NEWS LETTER 



ORIGINAL ARTICLE 



SOME RESPONSIBILITIES OF THE NAVY PHARMACIST IN QUALITY CONTROL OF DRUGS 

By Captain C. V. Timberlake MSC USN 



One of the most important aspects in tlie control of 
quality of drugs is the degree of inspection applied to 
an item just prior to its being used in compounding or 
dispensing to the patient. 

In general, the quality of drugs available to the Navy 
through the Medical Supply System, is far superior to 
that found in many of our civilian pharmacies, espe- 
cially in those more concerned with cut-rate discount 
operations. The military departments, through the 
Defense Medical Materiel Board and the Defense Med- 
ical Supply Center, employ elaborate and comprehen- 
sive means for monitoring or controlling the purity, 
quality, and strength of pharmaceuticals, including bi- 
ologicals and chemicals, which are centrally procured, 
stored, and issued to the world wide medical activities 
of the U. S. Navy. In the standardization, procure- 
ment, storage, and issue of these drugs, there are con- 
trols at every stage specifically designed to make 
available to the pharmacist only the best pharmaceuti- 
cals, in spite of the many pitfalls encountered in the 
competitive procurement required by Government Reg- 
ulations. This system, like all other man-devised opera- 
tions, is not perfect. The Defense Medical Supply 
System has tightened its control of quality to the extent 
that it can operate with such a degree of practical 
efficiency and assurance that only quality medications 
are received by the patient. 

There is still, however, one link in the chain of 
quality control which has not received enough atten- 
tion, and which, in my opinion, is the most important 
link of all. That is the pharmacist who compounds, 
labels and dispenses the end product to his patient. It 
is at this point that the last opportunity presents itself 
for the Navy pharmacist to exercise his scientific and 
professional training, experience, and judgment in con- 
ducting a final inspection of the medication before 
handing it to the ultimate user. 

Now, what are some of the ways the pharmacist may 
strengthen this last link in the chain of quality control 
of drugs? First, he must bring into practice all the 
scientific, professional experience and judgment that 
he has acquired in becoming, and in functioning as, an 



expert in the compounding and dispensing of medica- 
tions. Second, he should maintain a constant close 
surveillance of those items which bear an expiration dat- 
ing and/ or which require special storage conditions. 
Third, he should promptly report and suspend from 
issue and use, any item suspected of being defective or 
deteriorated. 

Too many of our dispensing pharmacists aie not 
really aware of the many areas in which they can 
assure that only first class medications are dispensed. 
For example, close inspection may reveal the following: 
Tablets — (uncoated) — May have chipped and over- 
turned edges which are irritating to the throat when 
swallowed, not to speak of the lowered potency of 
tablets having large chips missing. Tablets may be 
speckled or mottled, evidence in some cases that con- 
tamination exists or that the formulation was not 
properly mixed prior to the tableting process. Thyroid 
tablets and other uncoated tablets of glandular sub- 
stances, due to their peculiar formulation, are character- 
istically mottled in appearance and may not be defective. 
The pharmacist should become acquainted with these 
products and processes and understand why. Tablets 
may vary in size and weight which would result in non- 
uniform availability of the active ingredient (s). Non- 
uniformity of color or appearance of tablets should be 
cause to suspect that the tablets are not of viniform 
quality and/ or may indicate some degree of deteriora- 
tion: For example, the darkening of Aminosalicylic 
Acid tablets, the formation of crystals (of salicylic acid) 
on tablets, even on the sides of the container of aspirin 
tablets, or, as has been observed, the presence of me- 
tallic chips (apparently from tableting machines) im- 
bedded in or on the tablets. An odd or unusual odor 
from the stock bottle may indicate that deterioration or 
decomposition has taken place, e.g. Aminophylline Tab- 
lets in which a strong ammoniacal odor, with or without 
discoloration of the cotton space filler, has developed. 
Tablets — (coated) — May show evidence of chipping, 
cracking, peeling, pitting, mottling or other surface 
defects which may indicate deterioration. This is es- 
pecially important if the tablet happens to be enteric 



U.S. NAVY MEDICAL NEWS LETTER 



11 



coated. An imperfect coating may permit the release 
of the active ingredient (s) prior to entering the intestinal 
tract. Occasionally, coated tablets, e.g. (Ferrous Sul- 
fate or Chlorpheniramine Maleate, etc.) will change 
color from within the tablet outward. 
Parenteral Preparations — Upon visual inspection these 
may show the presence of particulate or undissolved ma- 
terial. They .should be substantially free from such 
foreign matter or promptly suspended from issue. Ex- 
ceptions to this are, e.g. Sterile Epinephrine Suspen- 
sion and types described on page 817 of the USP XVI . 
This inspection is easily performed by inverting the 
bottle, ampoule, etc.; and twirling it against a light, then 
a dark, background which would immediately reveal 
the presence of particulate matter. I have actually 
found a housefly contained in a 30 cc hermetically 
sealed container of distilled water for injection. Fleas 
have been found in hermetically sealed tubes of sterile 
gut suture material. For material bearing the same 
lot, control, or batch number, non-uniformity of color, 
or presence of color in a normally colorless solution, 
almost always indicates a defective product and should 
be reason for suspicion. Cracked or leaking ampules 
or vials, frequently found on opening the unit container, 
are usually due to damage incurred during shipment 
and handling unless there is definite evidence of closure 
failure. Leakage combined with a definite shortage in 
net volume content would justify the suspicion that the 
contents are no longer sterile. 

Suspensions, Magmas and Emulsions — On short term 
standing, these preparations usually exhibit some de- 
gree of separation into a lower, more viscid or dense 
portion, and a smaller, more limpid or less dense upper 
portion. Upon shaking vigorously for 2 to 3 minutes 
(longer for large bulk containers, e.g. 1 pint to 1 gallon) 
they should become uniformly homogeneous, readily 
pourable, and of normal color and appearance. Some 
suspensions, e.g. Trisulfapyrimidines Suspension, and 
Chloramphenicol Palmitate Oral Suspension, on long 
standing, become so thick and viscid that even several 
minutes of vigorous shaking does not render them ho- 
mogeneous or pourable. Garnet red crystals have been 
observed in the above Trisulfa Suspension. The pres- 
ence of gaseous pressure and/ or an unpleasant odor 
when units are first opened are usually an indication of 
deterioration by fermentation. 

Suppositories — (rectal) — May not be uniformly tapered 
to a point and may contain crystals on the surface 
which could cause irritation when inserted. This is also 
evidence of poor formulation and uneven distribution 
of active material. A foreign odor, not characteristic, 
may be evidence of contamination and should be reason 
for suspicion. Misshapen or collapsed suppositories 
would indicate improper storage of item. 

(vaginal) — Same defects may be found as in rectal 
suppositories; however, vaginal suppositories are ovoid 
in shape. 



Ointments — Upon examination, many ointments may be 
noted to contain lumpy or gritty material, to show non- 
uniformity in color and consistency, and to be rancid. 
Chemicals: Organic, Inorganic — Most chemicals are 
white (or "colorless"), although there are many notable 
exceptions, e. g. Sulfur, Charcoal, Iodine, Iron Salts, 
lodochlorhydroxyquin, etc. Therefore, any noticeable 
departure from the normal color should lead to suspi- 
cion of improper identity, or of contamination or 
deterioration. Some chemicals, in time, attack the con- 
tainer's closure and become contaminated; some absorb 
moisture or carbon dioxide and become altered physical- 
ly and chemically; some become caked, fused, or 
massed; others become more friable. Some drugs devel- 
op a foreign odor; in others the initial odor becomes 
weakened. Before using a stock chemical for com- 
pounding and dispensing, or for testing, the Navy 
pharmacist should assure himself that the item corre- 
sponds with the known description; if it does not he 
should investigate. 

Asecond most important link in the chain of quality 
control by the pharmacist is the close check which must 
be kept on dated products. Material, which is nearing 
the expiration of its stated potency period, should be 
plainly and conspicuously marked so that the material 
is not inadvertently dispensed beyond that period. Nor 
should the patient be dispensed medication which would 
expire during the medication period. To preclude this, 
it would be wise in include the expiration date of the 
item (if short-dated) on the label of the dispensed 
medication. As a further extension of quality control 
safeguards, it is good practice to include the manufac- 
turer's name and lot number on the filed prescription 
in the event an unusual or untoward reaction occurs, in 
which case it would be relatively simple to positively 
identify the material and initiate an adverse drug reac- 
tion report. (In this connection, I'm afraid, too many 
dispensing pharmacists do not recognize the importance 
of assigning manufacturer's names and lot or control 
numbers to prescriptions. We know that Federal Laws 
require this information to be included as a part of the 
label of the item by the manufacturer. Then why should 
we permit the pharmacist to dispense the item to the 
ultimate user without recording the same information 
on the filed prescription? Three or four days later the 
patient may develop a reportable reaction to the drug, 
yet the pharmacist may be unable to positively identify 
the manufacturer and/or the lot number since the orig- 
inal stock bottle or container may have been discarded. 
This would seem to me a compromise of the entire 
quality control system precisely at the most important 
stage. As a matter of fact, complaints have been re- 
ceived from military installations on drug items with the 
name of the manufacturer and lot number listed as 
"unknown.") 

The final and one of the most important steps the 
dispensing Navy pharmacist can take in carrying out his 
responsibility as a guardian of quality medications is 



12 



U.S. NAVY MEDICAL NEWS LETTER 



that of immediately suspending from issue and use, and 
reporting via established procedure, any material sus- 
pected of being defective. In doing this, he will not 
only advise the Defense Medical Supply Center of de- 
fective material, which may be replaced by the manu- 
facturer at no cost to the government, but cause action 
to be taken to suspend the material from issue and use 



throughout the supply system if further investigation 
reveals it to be defective, or, perhaps, even dangerous 
to use. 

Again, let me emphasize that the dispensing pharma- 
cist is the final and most important link in the "Quality 
Control Chain" which guarantees that only high quality, 
effective and safe medications reach the patient. 



Pathogenesis and Treatment of Urinary Infection 



B. G. Clarke MD, Associate Professor of Urology, Tufts University School of 
Medecine and J. Hart well Harrison MD, Clinical Professor of Genito-Urinary Surgery, 
Harvard Medical School. Reprinted by permission of the authors from "Diseases of 
the Urinary and Genital Organs" (A Review and Bibliography) — pps 20-26, Boston, 
Mass., 1960. 



Tables 1,2, and 3, reproduced through the courtesy 
of Dr. George Austen, summarize data based on experi- 
ence of the Boston University Urology Service at Boston 
City Hospital in March 1960. 

Table I 
Antibacterial Agents — GU Infections 



Vancomycin @ 
Ristocetin 



Polymyxin B.* 
Colimycin * 



Mandelamine 



Bactericidal 
Penicillin 
Streptomycin 
Kanamycin 
Humycin 
Neomycin 
Bacitracin 
Vancomycin 
Polymyxin B. 
Colimycin 
Ristocetin 



Bacteriostatic 

Tetracyclines 

Chlortetracycline 

Oxytetracycline 

Tetracycline 

Demethylchlortetracycline 
Chloramphenicol 
Erythromycin 

Ilotycin 

Oleandomycin 

Carbomycin 

Spiramycin 
Novobiocin 

Cathomycin 

Albamycin 
Sulfonamides 
Nitrofurantoin 
Mandelamine 



Table II 

Antibacterial Drugs — Spectrum of Activity 

Primarily Gram Primarily Gram Broad 

Positive Negative 

Penicillin Streptomycin ^ 

Erythromycin * Kanamycin * 

Novobiocin ^ Humycin * 

Bacitracin Neomycin * 



Spectrum 

Tetracyclines 
Chloramphenicol 
Sulfonamides 
Nitrofurantoin 



H- ^ Bacteriostatic 

@ = Occasionally effective for gram negative organisms (Proteus) 

* ^ Occasionally effective for gram -^ organisms also. 

Of Utmost importance in treatment of urinary infec- 
tions, even when they are apparently cured, is that 
treatment be continued long enough, and that follow-up 
(by clinical means, urinalyses and cultures) be carried 
out for months after apparent cure and discontinuance 
of treatment. Cultures may be negative during treat- 
ment, only to become positive later. Long observation 
assures that asymptomatic recrudescence of bacterial 
growth does not appear and that the risk of chronic 
pyelonephritis and its long term fatal sequelae of hyper- 
tension and renal failure be minimized. 

Antibiotics. VI. Neomycin, Polymixin, B. Bacitracin and Tyrothricin. 

Waisbren, B.A.: New England J Med 258: 1213-1215, June 12, 

195S. 
The Place of Novobiocin in Genito-Urinary Tract Infections. Seneca, 

H.; Lattimer, J.K.; and Johnson, A.: J Urol 79: S82-89I, May 1958. 
Penicillin (Current Concepts in Therapy, Prepared by the Journal's 

Committee on Advertising). New England J Med 255: 88-89, July 

12, 1956. 
Polymyxin B in Chronic Pyelonephritis. Observations of the Safety 

of the Drug and its Influence on Renal Infection. Hopper, J. Jr.; 

Jawetz, E.; and Hinman, F. Jr.: Am J M Sc 225: 492-509, April 

1953. 
Antibiotics. VII, Streptomycin in Nontuberculous Infections. Ham- 
burger, M.: New England J Med 259: 85-88, July 10, 1958. 
Clinical Experience with Terramycin in Treatment of Refractory 

Urinary Tract Infections. Nesbit, R.M,; Adcock, J,; Baum, W.C; 

and Owen, C.R.: J Urol 65: 336-342, February 1951. 
Tetracycline in Genito-Urinary Infections. Sanford, J. P.; Favour, C.B.; 

Harrison, J_H.; and Mao, F.H. : New England J Med 251: 

810-813, November 11, 1954. 
A Comparative Evaluation of Sulfonamides. Daeschner, C.W.; Clark, 

J. L.; and Yow, E.M.: J Pediat 50: 531-551, May 1957. 
Elkosin in the Management of Urinary Tract Infections (Sulfisomi- 

dine— Ed.) BoBfliih. M; Ellis, H.; and Murphy, J. J.: JAMA 161: 

1564-1565, August 18, 1956. 



U.S. NAVY MEDICAL NEWS LETTER 



13 



Sulfamethoxpyridazine in Urinary Tract Infections. Harris, A. P.; 
Rudy, H. D. Jr.; and Kniglit, V.; Arch Int Med .100: 701-708, 
November 1957. 

Observations on the Use of Sulfiosoxazole (Gantrisin) in 1,000 Con- 
secutive Patients witli Particular Reference to the Frequency of 
Undesirable Side Effects. Yow, E.M. : Am Pract and Digest of 
Treatment 4r 52S-52S, 1953. 

Thiosufil for Chronic Urinary Tract Infections (Sulfamethylthjadiazole 
—Ed.) Barnes, R.W.: J Urol 71: 655, May 1954. 

Current Practices in General Medicine. Infections of the Urinary 
Tract. Martin, W.J.; Nichols, D.R.; and Cook, E.N.: Proc Mayo 
Clinic 34: 187-200, April 15, 1959. 



Eflects of Antibiotics and Vaccination on Experimental Pyelonephritis. 
Weyrauch, H.M.; Rosenberg, M.L.; Amar, A.D.; and Redor, M,: J 
Urol 78: 532, 1957. 

Nitrofurantoin. Clinical and Laboratory Evaluation. Waisbren, B.A,; 
and Crowley, W.: AMA Arch Int Med 95: 653-661, May 1955. 

Demethylchlortetracycline. A New Tetracycline Antibiotic that Yields 
Greater and More Sustained Antibacterial Activity. Kunin, CM.; 
and Finland, M.: New England J Med 259: 999-1005, November 
20, 1958. 

Antibiotics. IX. Chloramphenicol. Jackson, G.G. New England J Med 
259: 1172-1174, December li, 1958. 



TABLE III 

Drug Therapy of GU Infections 
Drug of Choice 



ACUTE 

INFECTION 



Alternative * 



Ambulatory 



STAPH. 



PENICILLIN (ERYTHROMYCIN iNOVOBIOCIN 

( CHLORAMPHENICOL (CHLORAMPHENICOL 

VANCOMYCIN 



PENICILLIN (P.O.) 
TETRACYCLINES 



STREP. 
ENTERO- 
COCCUS 

GONOCOCCUS 



PENICILLIN ERYTHROMYCIN BACITRACIN 

STREPTO- (CHLORAMPHENICOL RISTOCETIN 
MYCIN /STREPTOMYCIN 



PENICILLIN ERYTHROMYCIN 



TETRACYCLINES 
SULFA 

ERYTHROMYCIN 
MANDELAMINE 



PENICILLIN 



E. COLI 



CHLORAM- 
PHENICOL 



I STREPTOMYCIN 
) CHLORAMPHENICOL 
COLIMYCIN 



POLYMYXIN B. 

KANAMYCIN 



COLIFORM 



CHLORAM- 
PHENICOL 



j STREPTOMYCIN 
( CHLORAMPHENICOL 
COLIMYCIN 



POLYMYXIN B. 
KANAMYCIN 



A. AEROGENES 

-f 
( FRIED- 
LANDER'S) 

Ps. AERUGINOSA 



CHLORAM- 
PHENICOL 



(STREPTOMYCIN 
1 CHLORAMPHENICOL 
COLIMYCIN 



POLYMYXIN B. 

KANAMYCIN 



SULFA i CHLORAMPHENICOL COLIMYCIN 

CHLORAM- (STREPTOMYCIN POLYMYXIN B. 

PHENICOL TETRACYCLINES 
KANAMYCIN 



PROTEUS 

H. INFLUENZEE 
TUBERCULOSIS 



SULFA t CHLORAMPHENICOL NOVOBIOCIN 

I STREPTOMYCIN VANCOMYCIN 

TETRACYCLINES 

KANAMYCIN 



SULFA 

NITROFURANTOIN 

TETRACYCLINES 



STREPTO- CHLORAMPHENICOL KANAMYCIN 

MYCIN KANAMYCIN CHLORAMPHENICOL 



STREPTO- 
MYCIN '■■• 



PAS + ISONIAZID 



CYCLOSERINE 



* ONLY AFTER SENSITIVITY TESTS 



14 



U.S. NAVY MEDICAL NEWS LETTER 







TABLE 


IV 












Drug Therapy of GU Infections 








Av. Daily 


Max. Daily 


Av. Blood 


Max. Blood 


Urinary 


Resistant 


Drug 


iDose. Gms. 


Dose Gms. 


Level /ml 


Level /ml 


Level /ml 


/ml 


SULFA 


4.0-6.0 


6.0 


50 


200 


500 


500 


PENICILLIN 


L2 mil. U* 


6.0-10.0 mil. U * 


2-5 


50 


1000 


1000 


STREPTOMYCIN 


LO* 


4.0 * 


20 


50 


250 


250 


KANAMYCIN 


1.0* 


2.0* 
(max. total 40.0) 


2-5 


25 


1000 


1000 


HUMYCIN 














NEOMYCIN 


0.6* 


0.6 * 










POLYMYXIN B. 


0.10* 


0.25* 


3 


12 


100 


200 


COLIMYCIN 


2.0 mil. U * 


4-8 mil. U * 


2.5-4.5 


? 


HIGH 


HIGH TITERS 


CHLORAMPHENICOL 


1.0-2.0 


4.0 or 1.0 4- 


3 


12 


200 


200 


TETRACYCLINES 


1.0-2.0 


4.0 or 1.0 + 


3 


12 


200 


200 


NITROFURANTOIN 


0.3-0.4 


0.6 





5 


10 


10 


ERYTHROMYCIN 


1.0 


4.0 or 2.0 + 


3 


12 


200 


200 


OLEANDOMYCIN 


1.0 


4.0 or 2.0 + 


3 


12 


200 


200 


NOVOBIOCIN 


1.0 


4.0 or 2.0 + 


3 


12 


200 


200 


VANCOMYCIN 


2.0 + 


2.0 + 


5 


5 


HIGH 


HIGH TITERS 


BACITRACIN 


100,000 U * 


100,000 u+* 










RISTOCETIN 


1.0-2.0 + 


2.0 + 












t- ^= 


Intramuscular 


+ = Intravenous 







HAZARDS OF TREATMENT 

Every drug powerful enough to eradicate organisms 
from the urinary tract has the capacity for producing 
severe reactions. Antibacterial agents should not be 
employed until it has been ascertained that the patient 
has no history of sensitivity to similar drugs or other 
contra-indications. 

With exposure to any antibacterial agent microor- 
ganisms, if they are not immediately eradicated, tend to 
develop drug resistance. This is a hazard in any of 
long-term therapy, particularly when chronic infection 
or structural urinary tract abnormality lessen the chance 
of immediate cure. Drug-resistant strains are capable 
of causing acute, and sometimes fatal, exacerbations of 
infection and are particularly hazardous on account of 
the inaccessibility of the organisms to effective therapy. 

A "superinfection" is an infection developing, often 
elsewhere than in the primary site of infection, when 
one element of microbial flora of the body is suppressed 
by specific antibacterial therapy. Other strains, freed 
from competition for sustenance, multiply to produce 
drug-resistant clinic infections. For example, a patient 
with an indwelling urethral catheter might harbor a sub- 
clinical cystitis due to strains of staphylococci and E. 
coli which ordinarily hold each other in check by com- 
petition. The "prophylactic" administration of penicillin 
might eliminate the staph, allowing the development of 
acute E. coli cystitis, pyelonephritis, and septicemia. 

U.S. NAVY MEDICAL NEWS LETTER 



A widespread practice has developed of giving various 
antibacterial drugs, usually in low doses, to patients 
with indwelling catheters. This, it is assumed, may 
reduce the incidence of urinary infection. It is clear, 
however, that infection can almost never be eliminated 
from the urinary tract until the catheter is no longer 
necessary regardless of what drugs are used. "Prophy- 
lactic" administration of antibiotics, sulfonamides or 
other antibacterial agents exposes the patient to the 
hazards of drug toxicity, of superinfection, and of the 
development of drug-resistant urinary flora. When 
acute complications such as acute pyelonephritis, 
urethritis, prostatitis or epididymitis due to such flora 
occur, they cannot be treated successfully by the usual 
measures. 

Because of the danger of renal failure and hyperten- 
sion associated with unrecognized chronic pyelonephritis 
patients who have been treated for urinary infections 
with apparent success must be studied for long intervals 
until it is certain that they are free of infection. 

As an arbitrary doctrine, it may be stated that any 
patient in whom symptoms have not subsided and 
urinary cultures become negative within 48 hours of 
beginning treatment must be regarded as a treatment 
failure and be promptly re-evaluated. In general, treat- 
ment should be continued for at least a week after 
clinical remission. 



15 



Infections Occurring During Cliemotherapy. A Study of Their Fre- 
quency, Type and Predisposing Factors. Weinstein, L,; Goldfieid, 
M,; and Chang, T.W.: New England J Med 251: 247-255 August 
12, 1954. 

A Study of Antibiotic Prophylaxis in Unconscious Patients. Peters- 
dorf, R.G.; Curtin, J.A.; Hoeprieh, P.D.; Peeler, R.N.; and Ben- 
nett, r.L.: New England J Med 257; 1001-1009, November 21, 1957. 

Emergence of Antibiotic-Resistant Bacteria. Finland, M.; New Eng- 
land J Med 253: 909-922, November 24 and 969-1028, December 8 
1955. 

Antibiotics. III. Absorption and Excretion and Toxicity. Finland, M.: 
New England J Med 258: 544-546, March 13, 1958. 



Reactions to Benzathine Penicillin. McFarland, R.B.: New England J 
Med 259: 62-65, July 10, 1958. 

Follow-up Study of Fatal Penicillin Reactions. Special Report. Rosen- 
thal, A.: JAMA 167: 1118-1121, June 28, 1958. 

Thrombocytopenic Purpura Resulting from Sulfioxoxazole (Gantrisin) 
Therapy. Report of Two Cases. Green, T.W.; and Early, J.Q.: 
JAMA 161: 1563-1564, August IS, 1956. 

Chloramphenicol (Chloromycetin) in Relation to Blood Dyscrasias 
with Observations on Other Drugs. Lewis, C.N.; Putnam, L.E.; 
Hendricks, F.D.; Kevlan, L; and WeSch, H.: Antibiotics and'chem- 
otherapy 2: 601-608, December 1952. 



FROSTBITE 

By Bradford Washburn -^ 
Director, Museum of Science, Boston, Mass. 
(This article is reproduced from The Polar Record, Vol. //, No. 75, September 1963) 
by kind permission of the author and the editor of that journal. It originally appeared 
in the American Alpine Journal 13: 1, 26 June 1962, and was reproduced, in slightly 
different forrn, in the New England Journal of Medicine 266: 974-989, May 10, 1962. 
This article is a slightly shorter version containing subject matter from both originals. 
Appreciation is extended to Mr. Washburn for permission to publish this article in the 
Medical News Letter. — Editor) 



MEDICAL BACKGROUND 

Frostbite is much better understood than it was little 
as a decade ago, but there are still some areas of disa- 
greement even among experts regarding the details of 
both pathology and treatment of the injured part. This 
article is a summary of what I believe to be the soundest 
present thinking on the subject. 

Except in rare and dramatic cases, frostbite is re- 
stricted either to the extremities of the body or to areas 
like the heels, chin and cheeks, nose and ears. Adequate 
circulation of blood not only keeps the extremities warm 
but also provides a constant supply of oxygen and nour- 
ishment to the cells. Any substantial disruption of this 
circulation causes damage to the tissue involved and 
frostbite, no matter how trivial, results in just this. The 
severity of the injury is influenced by the intensity of the 
initial exposure and the length of time before adequate 
circulation can be restored. Arteries carry fresh blood 
from the heart to nourish the body. As they proceed 
through the system, they repeatedly fork and subdivide 
so that, as the extremities and surface of the skin are 
approached, the stream of blood which they carry gets 
smaller and smaller. At the very end of the line, the 
actual transition from artery to vein occurs in what is 

* For further information about the author, see the Medical News 
Letter Vol. 44, No. 7, in which the first installment of this article 
appeared. 



known as a capillary loop — and our vital tissues are 
honeycombed with myriads of these loops which form 
capillary beds. 

After an artery has tapered to an extremely small 
size, with an outside diameter of about a fifth of a milli- 
metre, it is known as an arteriole. After passing 
through the arterioles, the blood enters the intricate 
maze of infinitesimal capillaries. Unlike the arteries 
and arterioles, the capillaries are not sheathed in muscle. 
They are tiny hairiike tubes about a millimetre long and 
only about one-hundredth of a millimetre in diameter — 
so small, in fact, that red blood cells travel through 
them virtually in single file. Several capillaries are sup- 
plied with blood by a single arteriole. This network re- 
converges into a single venule at the terminus of the 
capillary bed. 

The transfer of oxygen and nourishment from the 
bloodstream to the body tissues takes place in these 
capillary beds — passing directly through the delicate 
walls of the capillaries to feed the living cells adjacent 
to them. Under normal conditions, the capillaries are 
impervious to the blood itself (both plasma and cor- 
puscles) which travels through them into the venules, 
then to the veins, and back to the heart, kidneys and 
lungs for purification and revitalization before starting 
another circuit through the body. 



16 



U.S. NAVY MEDICAL NEWS LETTER 



It is in the arterioles that the initial reaction leading 
to frostbite takes place, and this reaction is the result of 
the important basic difference in structure between the 
arterioles and the capillaries. 

An arteriole has a powerful system of muscles built 
into its resilient but microscopic walls. These muscles 
are innervated from the autonomic nervous system; 
consequently, when tissue is chilled, the arterioles in the 
area of contact instantly and involuntarily contract in an 
effort to prevent the excessive loss of body heat. If the 
chilling is only brief and moderate, the blood flow to the 
capillary beds merely slows down or is diverted to other 
nearby arterioles and capillaries not yet affected by this 
chilling. On the other hand, if the chilling is intense, 
the constriction of the arterioles in the chilled tissue can 
totally close them to the passage of blood. If such a 
reaction is only momentary, no damage occurs, but the 
longer it lasts, the more the chance of injury to the 
arteriole and to all the tissue it serves. 

A capillary, in sharp contrast to an arteriole, is com- 
posed of non-muscular tissues whose inner stream of 
blood never changes volume in a healthy person — al- 
though the movement of blood through the capillaries 



is not steady, but is constantly stopping and starting 
under the control of the minute precapillary sphincters. 
These extraordinary little valves are believed to be op- 
erated by infinitesimal changes in the chemical balance 
of the cells fed by each capillary. 

Two types of reaction appear to take place when one 
comes in contact with a very cold object. The super- 
ficial tissue at the site of contact actually freezes to a 
depth entirely dependent on the degree of cold and the 
length of the contact; and then, immediately below this 
"quick freeze" zone, the chilling makes the blood so 
viscous that capillary circulation comes to a halt — even 
though the tissue is not reduced to the freezing point. 
This superficial reaction is almost instantaneous (for 
example, if one grasps a metal object tightly at — 40°C 
(^40°F). 

If the part involved is not promptly rewarmed vaso- 
constriction of the arterioles in the chilled (but still 
unfrozen) adjacent tissue rapidly reduces the flow of 
blood in this zone. 

Nature then calls into play an extraordinary emer- 
gency circulatory mechanism, the "capillary shunt". 
When a capillary bed is chilled to the point of inactivity. 







:fe::wfR[:|:;:|:|:|:|:J>:|:|:;;;|:i:|:|:;:^^ 



U.S. NAVY MEDICAL NEWS LETTER 



17 



the arterial blood by-passes these capillaries entirely and 
travels directly from arteriole to venule in an effort to 
keep the chilled part warm and continue the otherwise 
bloclced circulation. This starts a flow of chilled blood 
back towards the heart, as well as totally depriving the 
shunted area of nourishment, for oxygen and food can- 
not pass through the walls of arterioles or venules to 
nourish tissue as they do in the capillaries — all that the 
blood in these vessels can do is to warm or cool ad- 
jacent tissue. 

Unless the source of cold is removed a sinister, 
vicious circle now starts. These shunts are not con- 
tinuous but start and stop in cycles, causing the area in 
danger to warm and chill in surges. If this cycle con- 
tinues in a crisis to a point where the loss of general 
body heat exceeds the victim's heat-producing capacity, 
the "core" temperature of the body begins to fall below 
the danger point, the cyclical shunts stop, and the 
extremity starts to freeze. Nature thus is able to sacri- 
fice an extremity rather than to risk the death of the 
whole organism. In this case, if the freezing part is not 
rapidly attended to, freezing can begin elsewhere, 
freezing at the original point of contact will deepen, 
and general cooling of the whole body will begin. This 
process can be greatly accelerated if the patient is in a 
state of panic or shock from other injury. Shock re- 
duces circulation to the extremities directly without the 
occurrence of any of these cycles. 

Although this automatic defence mechanism is excel- 
lent for the protection of the entire body under condi- 
tions of extreme cold, the total loss of some of the ex- 
tremities can be the dramatic result of this extraordinary 
involuntary effort of the whole organism to protect 
itself from injury. 

If the source of cold is below freezing point, the 
tissues wilt begin to freeze immediately after the initial 
spasm has slowed or blocked circulation. The exact 
cause of damage from frostbite is still a debatable sub- 
ject. There is little doubt that when tissue is chilled 
very much below freezing point, ice crystals begin to 
take form and grow between the cells. When the 
chilling is extremely intense — as from touching and 
holding extremely cold metal with damp hands or com- 
ing into direct contact with liquid gases in a laboratory 
— crystals are believed to form directly inside the cells. 
As yet little is known about this type of injury. If the 
source of cold is not removed, the extra-cellular crystals 
continue to grow, deriving the water for their growth 
from the contents of the adjacent cells. Curiously 
enough, it does not appear as if the temperature itself 
or the existence of these crystals between the cells dam- 
ages the cells themselves. However, unless this process 
is stopped very soon, the solution within the cells begins 
to become more and more concentrated as dehydration 
continues, and, after about half an hour, the cells appear 
to be severely damaged by this disruption of their own 
normal internal chemistry. It is believed that extremely 
fast and intepse freezing, which would result in the 



formation of ice crystals actually within the cells, would 
probably kill all the cells involved immediately, and no 
presently known form of treatment could revive them. 

It is interesting that tendons and bone are resistant to 
frostbite whereas nerves, muscles and particularly blood 
vessels are highly susceptible. 

It is obvious that as vasoconstriction slows and then 
stops the flow of blood through the capillaries, pro- 
longed removal of the steady flow of oxygen and 
nourishment to the adjacent tissues can lead to serious 
injury quite aside from the damage resulting from cell 
dehydration or ice-crystal formation. 

It is also most important to emphasize the fact that 
very serious injury to tissue can occur at temperatures 
well above freezing, provided conditions are cold enough 
and stay cold long enough to result in spasm and pro- 
longed blockage, or even a major slowdown of the 
capillary circulation. "Trench foot" and "immersion 
foot" are excellent examples of situations in which body 
tissue can be damaged as badly as by freezing, but with 
the external temperature never having to drop below 
about 10°C (50°F). This danger is only encountered, 
however, when parts of the body are kept immersed in 
frigid water or cold, wet clothing for long periods 
(Hedblom, 1961; Meryman, 1957). 

DESCRIPTION OF THE INJURY 

Mere numbness of toes, fingers or cheeks — followed 
by tingling after they have been rewarmed — does not 
constitute bona fide frostbite. True frostbite, even in its 
mildest form, does some real damage to the affected 
tissue. 

At the time of the Korean War, the United States 
Army divided frostbite into four distinct classes or de- 
grees, much in the same manner as burns. For the 
purpose of this description, however, I consider it best 
to classify frostbite in only two broad types: super- 
ficial and deep. In fact, the absence of reliable criteria 
with which to determine the true extent of frostbite 
injury until several days after the accident has always 
presented one of the greatest barriers to a full under- 
standing of its initial treatment. 

This simplified classification is now coming to be 
recommended by experts for two reasons: because it is 
very diflicult to assign most cases of frostbite definitely 
to one or another of the four Army classes (even after 
the injury has been completely cured); and, more im- 
portant from the practical standpoint, it is utterly im- 
possible even for an expert to apply the four-type 
classification of frostbite accurately at or near the time 
of injury. 

If the damage is only superficial the frozen part, 
though obviously white and frozen on the exterior, is 
soft and resilient below the surface when depressed 
gently and firmly before it has been thawed. In deep, 
unthawed frostbite, the injured part is hard and solid 
and cannot be depressed any more than wood or metal. 
However, these simple criteria are absent after thawing 



18 



U.S. NAVY MEDICAL NEWS LETTER 



has taken place, and time alone will reveal in retrospect 
the kind of frostbite that has been present. It is fortu- 
nate, therefore, that the treatment for all degrees of 
frostbite is identical in present medical practice, and an 
initial diagnosis of degree seems to be of little practical 
value. 

The following description, however, may help to give 
an understanding of what happens in the two basic 
types: 

Superficial Frostbite. This involves only the skin or 
the tissue immediately beneath it. There is a certain 
amount of whiteness or "waxy" appearance of the in- 
jured part at the outset. After rewarming, the frost- 
bitten area will first become numb, mottled blue or 
purple and then swell, sting and burn for some time. In 
more severe cases, blisters will occur in twenty-four to 
thirty-six hours beneath the outer layer of skin. These 
slowly dry up and become hard and black in about two 
weeks. General swelling of the injured area (oedema) 
will subside if the patient stays in bed or at complete 
rest — it will last much longer if he refuses to remain 
quiet. Throbbing, aching and burning of the injured 
part may persist for several weeks, depending on the 
severity of the exposure. After the swelling finally dis- 
appears, the skin will peel and remain red, tender and 
extremely sensitive to even mild cold, and it may per- 
spire abnormally for a long time. 

Deep Frostbite. This is a much more serious injury 
and its damage not only involves the skin and subcu- 
taneous tissue but also goes deep into the tissue beneath 
(even including the bone); it is usually accompanied by 
the formation of huge blisters. In marked contrast to 
superficial frostbite these take from three days to a week 
to develop, Swelling of the entire hand or foot will 
also take place, and may last for a month or more. 

During this period of swelling, there may be marked 
limitation of mobility of the injured fingers or toes, and 
blue, violet or grey (the worst) discoloration takes 
place. After the first two days, aching, throbbing and 
shooting pains may be experienced for two or eight 
weeks. The blisters finally dry up, blacken and slough 
off, sometimes in the form of a complete cast of the 
finger or toe, nail and all, leaving beneath an excep- 
tionally sensitive, red, thin layer of new skin, which will 



take many months to return to anywhere near normal. 
Sometimes, itching and abnormally great perspiration 
persist for more than six months after the initial injury, 
and the part will suffer lengthy or permanent sensitivity 
to cold. 

In extreme cases of deep frostbite that have not been 
rewarmed rapidly permanent loss of some tissue almost 
invariably occLirs. In such cases the skin does not be- 
come red and blistered after it has thawed, but turns a 
lifeless grey and continues to remain cold. If blisters 
occur, they will probably appear along the line of de- 
marcation between the acutely frostbitten area and the 
healthy remainder of the limb. In cases of acute deep 
frostbite of the foot, adjacent swelling can extend as 
high as the knee. 

In a week or two after injury, the tip of the injured 
area begins to become black, dry and shrivelled, but the 
rest of the damaged area may progress in one of two 
entirely dilferent ways: the tissue may all become black, 
dry and shrivelled to almost half the normal size and 
mummified right up to the beginning of the healthy 
flesh; or it may become wet, soft and inflamed, if in- 
fection enters the picture. In the dry type, the uninjured 
remainder of the limb usually does not become intensely 
swollen or painful, and there is a fairly clear line of 
demarcation between damaged and undamaged tissue. 
In the wet type, the whole limb tends to become painful 
and swollen, and originally undamaged tissue may suffer 
serious damage unless the infection is promptly checked. 

Surgical intervention is rarely needed in less than 
two months. Even minor surgery on frostbitten tissue 
should never be performed in the field. Under normal 
circumstances, in an extreme case in which the loss of 
some tissue is inevitable, despite careful treatment, the 
necrotic material will simply slough off at the proper 
point and at the proper time, with a maximum saving of 
the sound underlying tissue. 

Occasionally, when unsuccessful treatment has re- 
sulted in wet gangrene, professional surgical intervention 
to stop cellulitis may be needed in a hospital. How- 
ever, if even this type of case is kept scrupulously clean 
and sterile, the proper use is made of antibiotics and 
the patient stays constantly in bed at rest throughout 
the illness, the chances are high that autoamputation 
will eventually occur. (To be continued) 



RESUSCITATION INSTRUCTIONS 

The 12th Naval District Headquarters, San Francisco, 
has reproduced and distributed to all stations and ships 
in its area an estimated 400,000 copies of a Public 
Health Service wallet card featuring mouth-to-mouth 
resuscitation instructions. — Public Health Reports 
78(11): 954, November 1963. 



NEWSPAPER ADS AGAINST VD 

The New York City Department of Health is using 
newspaper advertisements in its campaign to curb ve- 
nereal disease. The ads symbolize the tragedies of the 
disease through the tears of a teenager. TV spot an- 
nouncements are also used. — Public Health Reports 
78(11): 954, November 1963. 



U.S. NAVY MEDICAL NEWS LETTER 



19 




DENTAL SECTION 



RELINING DENTURES WITH 
SILICONE RUBBER 



USE OF ANORGANIC BONE IN DENTISTRY 



Sauer, John L., Jr. 721 South Forest, Ann Arbor, 
Michigan. Jour Michigan D. A. 46: 101—106 April 
1964. 

Use of Dow Corning Silastic 390 Soft Liner as a 
resilient liner proved successful in seven dentures, a 
failure in one denture, and questionable in one denture. 

The patients, who ranged in age from 29 to 69 years, 
commented enthusiastically on the resilient liner. It 
was tolerated remarkably well by the oral mucosa. 

The silicone rubber resilient liner for dentures main- 
tained satisfactory physical properties under clinical 
conditions. Dimensional stability was satisfactory; 
dentures were not weakened by the use of the soft 
lining. Color stability was no problem and the dentures 
smelled clean and fresh after being rinsed and cleaned. 
The smoking habits of the patients did not affect the 
soft liner. Tea stained the rubber lining, but the stain 
washed off with finger pressure. Saliva and food de- 
bris were removed from the silicone rubber surface by 
ordinary rinsing and finger scrubbing. 

The main clinical problems were related to bonding 
and finishing. Bonding of the rubber to the acrylic 
resin failed if the rubber was packed directly against 
acrylic resin that had previously been in service. A 
satisfactory bond was obtained if new acrylic resin was 
interposed between the old resin and the rubber. 

If the denture peripheries were of soft rubber, finish- 
ing became a problem. No satisfactory method of 
finishing a soft periphery could be found, notwithstand- 
ing the manufacturer's directions. Dentures that were 
failures or qualified successes were so classified becpuse 
the finish was rough, uneven, or cut. Soft lined den- 
tures should not be cleaned with hypochlorite bleaching 
compounds; they cause the rubber to turn a yellow- 
white color. 



Alvin F. Gardner DDS PhD, University of Maryland, 
Baltimore, Md. Jour of Oral Surgery Anesthesia and 
Hospital Dental Service, 22: 332-340, July 1964. 

This article presents a review of all published experi- 
mental work relating to ethylenediamine extracted bone 
and its use as an implant material. Over fifty seven 
sources are listed in the bibliography of previous 
studies. The advantages of the use of chemically 
treated heterogenous bone grafts are carefully weighed 
against the always present disadvantages. The criteria 
for an ideal bone graft material are given as follows: 
( 1 ) the implant should be accepted with little or no host 
tissue reaction; (2) the implant material should be 
readily revascularized and (3) the implant should be 
resorbed rapidly and replaced by host bone. The con- 
sensus of the literature reviewed indicates that ethyl- 
enediamine treated bone satisfies all the requirements 
except the last. While early host acceptance, graft re- 
vascularization, and union with host bone are consistent 
findings in anorganic grafts, total replacement by host 
bone is prolonged over extended postoperative periods. 

In an effort to increase the resorption and replace- 
ment rate of anorganic bone the author has utilized 
beta-aminopropionitrile (BAPN) acid fumarate with the 
osseous implant. He reports that bone formation can 
be induced by this procedure. The author advocates 
the use of anorganic bone as a carrier for various sub- 
stances (e.g. BAPN) in more extensive investigations in 
an effort to find an optimal, inexpensive, readily avail- 
able source of osseous graft material for oral surgical 
use. (Submitted by CAPT. P. J. BOYNE DC USN 
USS Bon Homme Richard CVA-31). 



20 



U.S. NAVY MEDICAL NEWS LETTER 



ORGANIC FACTORS IN CALCULUS 
DEPOSITION 



Leung, S. Wah. Faculty of Dentistry, University of 
British Columbia, Vancouver 8, British Columbia, Can- 
ada, Proc Inst Med Chicago 25: 67-68, May 1964. 

Recent studies suggest that the organic matrix of 
calculus may play a more positive role in the formation 
of calculus than heretofore believed, and that a more 
effective means of inhibiting dental calculus may be 
found. Numerous past attempts to discover chemical 
means of removing or inhibiting calculus have been 
unsuccessful, chiefly because of the remarkable similar- 
ity in the inorganic composition of calculus and enamel. 
Materials which dissolve the inorganic salts of calculus 
usually have a similar effect on the teeth. 

Recent investigators have directed their attention to 
factors affecting the organic portion of calculus rather 
than the inorganic. The organic matrix seems to play 
an essential role in the calcification mechanism, particu- 
larly in providing the sites where nucleation of the cal- 
cium and phosphate crystals can occur. 

A variety of substances known to affect organic mol- 
ecules have been tested, especially enzymes. The 
enzymes most effective in inhibiting calculus appear to 
be those with high proteolytic activity and low carbo- 
hydrase activity. Such enzymes reduce calculus forma- 
tion by about 24 percent when incorporated into a 
tooth paste and used for six months. Other enzymes 
when incorporated into chewing gum also reduce cal- 
culus formation to some extent. Some success also has 
been reported with antibiotics and antiseptics. 



DENTAL HEALTH STATUS OF CHILDREN 

FIVE YEARS AFTER COMPLETING 

SCHOOL CARE PROGRAMS 



Galagan, Donald J., Law, Frank E., Waterman, George 
E., and Spitz, Grace Scholz. U. S. Public Health Serv- 
ice, Bethesda, Maryland. Public Health Reports 79: 
445-454, May 1964. 

Do school dental care programs continue to benefit 
participants and nonparticipants after the programs 
have been discontinued? Follow-up dental examina- 
tions conducted in Richmond, Indiana, and Woon- 
socket, Rhode Island, five years after the programs of 
comprehensive dental care were discontinued show that 
continuing benefits accrued in both communities. The 
habit patterns established during the Richmond and 
Woonsocket clinic programs carried over to a consider- 
able degree into the succeeding five years. 



The two projects, conducted for periods of five and 
six years, offered comprehensive dental care, including 
four successive treatment series in which the children 
received an examination, a dental prophylaxis, dental 
treatment as required, and topical fluoride applications. 
The educational phase of the programs was directed 
not only to participants and their families but to a 
community- wide audience. 

Follow-up studies showed that participants and non- 
participants alike sought and received considerably 
more dental care during the five years after cessation of 
the projects than had children of the same age during 
the five years preceding the clinic programs. However, 
proportionately less dental care was obtained during 
the five years immediately after termination of the 
projects by participants than had been obtained during 
the project itself. The data provide evidence of the 
importance of an uninterrupted program of regular 
care if the dental health needs of school children are 
to be fully and promptly met. 

For five years after termination of the clinic pro- 
grams, substantially larger numbers of carious teeth 
and substantially fewer restored teeth were present in 
children of every age. 

Even though this expected backsliding occurred, five 
years after the care program had ended the oral health 
status of all children in both communities was sub- 
stantially improved over that of chldren of the same 
age when the program was initiated ten years earlier. 
Every age-specific rate for carious teeth was smaller, 
and every rate for filled teeth larger than at the start 
of the program. For missing permanent teeth, there 
was an overall reduction in the number per child. 

The data suggest that some portion of the improve- 
ment in the health status of children in these two com- 
munities resulted from a change in their habits of 
seeking dental care. 



PERSONNEL AND PROFESSIONAL 
NOTES 

Increased Availability of Naval Dental School Short 
Courses. Improved teaching methods, made possible 
by advanced television techniques, have permitted the 
U. S. Naval Dental School to accommodate larger en- 
rollments in its series of short postgraduate courses. 
The remaining courses for this fiscal year are: 



Course 

Preventive Dentistry 
Captain Rovelstad 
Endodontics 
Captain Bucher 
Oral Surgery 
Captain Marble 



Dates 

Oct 19-23, 1964 
Oct 26-30, 1964 
Jan 4-8, 1965 



U.S. NAVY MEDICAL NEWS LETTER 



21 



Removable Partial Dentures 
Captain Kratochvil 
Complete Dentures 
Captain Stoll 
Oral Pathology 
Commander Green 
Occlusion 
Captain Rovelstad 
Operative Dentistry 
Captain Armstrong 
Oral Roentgenography 
Captain Parks 
Fixed Partial Dentures 
Captain Pepper 



Jan 25-29, 1965 
Feb 8-12, 1965 
Feb 8-12, 1965 
Feb 15-19, 1965 
Mar 1-5, 1965 
Mar 22-26, 1965 
Apr 19-23, 1965 



This increase in class size permits additional enroll- 
ment from those district and staff dental officers who 
have previously been assigned quotas as announced in 
U. S. Navy Medical News Letter 44(3); 26. Applica- 
tions from naval officers will be directed to the Chief, 
Bureau of Medicine and Surgery (Code 6), Navy De- 
partment, Washington, D.C. 20390. Army officers 
will forward their applications through the Surgeon 
General, U.S. Army, Washington, D.C. 20315. Ap- 
plications from Air Force officers will be made through 
the Director of Medical Staffing and Education, Office 
of the Surgeon General, Headquarters, USAF, Wash- 
ington, D.C. 20333. Applications from Veterans Ad- 
ministration officers will be directed to the Assistant 
Chief Medical Director for Dentistry, Department of 
Medicine and Surgery, Veterans Administration, Wash- 
ington, D.C, 20420. Public Health Service Officers 
will submit their applications through the Chief Dental 
Officer, Public Health Service, Department of Health, 
Education and Welfare, Washington, D.C. 20201. 

Availability of Stannous Fluoride and Compatible 
Pumice. The Procter and Gamble Company has noti- 
fied this Bureau that they will be unable to supply stan- 
nous fluoride and compatible pumice in the quantities 
announced in the U. S. Navy Medical News Letter 
44(5): 24, until the technical difficulties of packaging 
for shipment, etc., are overcome. Until the time that 
the larger packages are available, all facilities should 
order and utilize the starter and refill kits now available 
from the Procter and Gamble Company. 

The 7073 starter kit contains material necessary to 
perform 50 stannous fluoride prophylaxes and 50 topi- 
cal applications. The 7074 refill kit contains material 
necessary for 100 stannous fluoride prophylaxes. The 
cost of either kit is the same, $6.50, and can be ob- 



tained only from the one source noted below. (Mr. A. 
P. Austin, Proctor and Gamble Company, Winton Hill 
Technical Center, Cincinnati 24, Ohio). 

CB Center Hosts Meeting of Navy Dentists. The Dental 
Department, U.S. Naval Construction Battalion Center, 
Davisville, Rhode Island, hosted a meeting of dental 
officers stationed in the Narragansett Bay area, on 21 
August 1964. The guest speaker, William F. Varr, 
MD, is anesthesiologist at Kent County Memorial Hos- 
pital, Warwick, Rhode Island. Dr. Varr is a Diplomate 
of the American Board of Anesthesiology and a 
Fellow of the American Academy of Anesthesiologists. 
His topic, "The Management of Acute Emergencies 
in the Dental Operating Room" stimulated great inter- 
est as evidenced by the lively audience participation 
following his lecture. Over forty dental officers, rep- 
resenting CBC/CBLANT, Quonset Point, Newport, 
ASA, and several ships in the area, were present. 

The meeting concluded with a cake and coffee social 
hour, highlighted by the cutting of a birthday cake 
commemorating the fifty-second anniversary of the 
founding of the U.S. Navy Dental Corps. The official 
cake cutter was LT Paul L. Neary, DC USNR, the 
junior dental officer stationed in the Narragansett Bay 
area. 

Navy Dentist Lectures on Endodontics, The Fall Meet- 
ing of the Southwest Virginia Dental Society, on Thurs- 
day, 24 September 1964, at Bristol, Tennessee, featured 
a Clinic by CDR Edward C. Penick, DC USN. 

CDR Penick received his BS degree from Duke Uni- 
versity and DMD from the University of Louisville 
School of Dentistry. He has done postgraduate work 
at the U.S. Naval Dental School and graduate study at 
the University of Alabama Dental School. 

He entered the Navy after completion of Dental 
School and his assignments have included several tours 
of sea duty and numerous shore stations in the United 
States and the Far East. He was formerly head of the 
Endodontic Division at the U.S. Naval Dental School, 
Bethesda, Maryland. He is currently head of Endodon- 
tics at the Portsmouth Naval Hospital. CDR Penick has 
published several articles on Endodontics, He is a 
member of the American Dental Association and the 
American Association of Endodontists. 

Navy Dental Officer Presents Paper. CAPT G. W. 
Ferguson, DC USN, the Dental Officer, U.S. Naval 
Station, Newport, Rhode Island, presented a paper en- 
titled, "Rubber Dam" before the Texas Panhandle 
Dental Society on 28 September 1964 in Borger, Texas. 



Accident mortality would probably be reduced hy 20% if traffic casualties were given proper treatment before 
arrival in hospital. It is suggested that everyone who receives a driving license should be trained in first aid. 
—WHO Chronicle 18(9): 349, September 1964. 



22 



U.S. NAVY MEDICAL NEWS LETTER 



From the Note Book 



Indoctrination Courses for Medical Officers. In July 
1964 indoctrination courses were conducted for medi- 
cal officers at the U.S. Naval Academy and at the U.S. 
Naval Training Center, San Diego. Approximately 100 
indoctrinees participated in the two programs and each 
had the salient feature of being under orders to the 
operating forces. 

It is too soon to evaluate the effectiveness of the 
courses in terms of the indoctrinees' performance in 
their respective duty assignments. However, the recep- 
tion and attitude of the students, as reported by the 
instructors, have given us every indication that the 
courses were a tremendous success. 

Because of the large turnover of medical officers on 
active duty each summer, it has been necessary in the 
past to assign some officers to operational billets with 
a minimum of military indoctrination. Needless to say, 
this has invited adverse criticism from many operational 
commanders. Every effort has been made by this Bu- 
reau to provide adequate indoctrination programs for 
new officers reporting from civilian life. With the two 
established courses in July, and the other less formal 
courses held in naval hospitals and certain major ffeet 
commands, we are making considerable progress to- 
ward solving the problem. 

The course at San Diego was held this year for the 
first time. Instructors were drawn from various Navy 
and Marine Corps commands in the area. Field trips 
were conducted to local points of interest and to se- 
lected fleet commands. 

The course at the Naval Academy was more estab- 
lished. The same course had been presented at the 
Oflficer Candidate School, Newport, Rhode Island dur- 
ing the two previous years. Only the location and a 
few of the instructors were changed. This change was 
necessitated by the lack of BOQ facilities at Newport. 
To compensate for this sudden transferral of the course, 
it was necessary to bring some experienced instructors 
from Newport. A number of instructors v.'cre carefully 
selected from the Washington area to supplement the 
teaching staff from Newport. 

— Medical Corps Branch, 

Professional Division, BuMed. 



Technician Training Available for Volunteer Hospital 
Corpsmen. Nominations are urgently needed for 



courses of instruction in Submarine Medicine, Nuclear 
Medicine, Pharmacy and Medical Deep Sea Diving 
Technic for classes to be convened during the next six 
months. Applicants should be qualified in accordance 
with eligibility requirements set forth in BUMEDINST 
1510.41 and Chapter 12.2, Enlisted Transfer Manual 
as applicable. In order to assure adequate lead time in 
issuing orders personnel desiring assignment to the above 
courses of instruction are requested to submit applica- 
tions as soon as possible, 

— Director, Hospital Corps Division, BuMed. 

BUMED INSTRUCTION 6230. llC 

From: Chief, Bureau of Medicine and Surgery 

To: All Ships and Stations 

Subj: Malaria; control and prevention 

Ref: (a) NAVMED P-5052-10, Malaria: Clinical 
Features, Treatment, Control, and Preven- 
tion; 30 Jun 1959 (NOTAL) 

(b) Control of Communicable Diseases in Man, 
current edition, American Public Health 
Association, 1790 Broadway. N.Y., N.Y, 
(NOTAL) 

(c) NAVMED P-5042, Film Reference Guide 
for Medicine and Allied Sciences, current 
edition (NOTAL) 

(d) NAVMED P-5010, chapters 9, 10, and 11, 
Manual of Naval Preventive Medicine 
(NOTAL) 

1. Purpose. To establish policy regarding the control 
and prevention of malaria in Navy and Marine Corps 
personnel and their dependents. 

2. Cancellation. BUMED Instruction 6230. i 1 B is 
canceled. 

3 . Background 

a. Malaria has seriously interfered with military op- 
erations in the past and can do so again when military 
forces are operating in malarious areas. Military ma- 
laria control and prevention depend on mosquito con- 
trol, individual protective measures, and chemo-prophy- 
laxis as outlined in references (a) and (b) . Under mobile 
tactical situations, drugs and personal protective meas- 
ures must be relied upon for malaria prevention since 
control of the mosquito and its environment may not 
be feasible or practicable. 



U.S. NAVY MEDICAL NEWS LETTER 



23 



b. The naval operating forces may be required to 
deploy component units on short notice to any place in 
the world to accomplish a wide variety of missions. It 
is necessary, therefore, that components of the operat- 
ing forces subject to deployment to malarious areas be 
prepared at all times to institute chemo-prophylactic 
and other preventive measures. 

c. Recent studies reported by the U.S. Air Force, 
including altitude stresses, psychomotor performance, 
and other pharmacologic investigations reveal no speci- 
fic contraindication to the use of combined chforoquine- 
primaquine prophylaxis as described in subparagraph 
4c. The same precautions which pertain to adminis- 
tration of any drug to flight personnel in accordance 
with accepted aviation medicine practices are recom- 
mended. 

d. In several areas of the world, strains of malaria 
parasites have been found that are resistant to one of 
more antimalarial drugs. While at the present time 
these strains are only a small minority of all strains, 
they pose a definite threat to any military or naval op- 
erations that may take place in an endemic area. It 
is essential that the Bureau of Medicine and Surgery 
be informed of all patients with malaria suspected of 
being drug-resistant so that appropriate action, includ- 
ing therapeutic trials, may be initiated promptly. 

4. Action 

a. Fleet or force commanders are requested to direct 
those subordinate units which are subject to operations 
in malarious areas to maintain a 3-month supply of 
malaria control and prophylaxis material on hand at 
all times and shall direct its use when indicated. 

b. Personnel serving in areas where malaria is a real 
or threatened hazard or serving with units subject to 
deployment in such areas shall be instructed regarding 
the nature and transmission of the disease and in the 
use of personal protective measures including, where 
indicated, protective clothing, bed nets, insecticides, and 
repellents. Reference (c) provides a list of training aids. 

c. In addition to the use of personal protective meas- 
ures, Navy and Marine Corps personnel, including avia- 
tion flight personnel, exposed to the risk of acquiring 
malaria, shall be placed on chemoprophylaxis as fol- 
lows: 



(1) One tablet once-a-week of combined Chloro- 
quine and Primaquine Phosphates (FSN 6505-753- 
5043 or FSN 6505-854-2239) for the duration of ex- 
posure. 

(2) Upon termination of the risk of exposure, con- 
tinue weekly doses of the combined Chloroquine and 
Primaquine Phosphates tablet for 6-additional weeks. 

d. Dependents and civilian personnel under the cog- 
nizance of the Navy Department, living in areas where 
malaria is a real or threatened hazard, may receive 
chemoprophylaxis on a voluntary basis as follows: 

(1) Adults. Chloroquine and Primaquine Phos- 
phates tablet once weekly as for military personnel in 
subparagraphs 4c(l) and (2). 

(2) Children 

(a) Pyrimethamine (Daraprim) tablet, 150 mg., 
(nonstandard) is recommended in the following dosage: 



Body Weij^ht 
15-29 pounds 
30-59 pounds 
60-99 pounds 
100 or more pounds 



Weekly Dose 

^1.5 mg. base (14 tablet) 

75.0 mg. base (1/2 tablet) 

150.0 mg. base ( 1 tablet) 

300.0 mg. base ( 2 tablets) 



(b) As an alternate drug for children, chloro- 
quine base in a dose not to exceed 5 mg per kilogram 
of body weight may be used. In case of vivax malaria, 
this drug only suppresses manifestations of the dis- 
ease during administration. 

e. Adverse or unusual reactions to the use of chemo- 
prophylactic drugs should be reported promptly to 
BUMED (Code 72). Likewise, BUMED should be in- 
formed by message whenever the existence of a drug- 
resistant strain of malaria parasite is suspected. Sus- 
picion should be aroused when normally adequate doses 
of malarial drugs fail to prevent or cure clinical malaria 
or parasitemia. 

f. Measures for the control of the mosquito and its 
environment shall be instituted to the extent practicable 
under the particular military situation. Reference (d) 
provides information on methods for mosquito control 
aboard ship and ashore. 

R. B. BROWN 
Acting 



DETERGENT WASTES 

Evidence of widespread seepage of detergents from 
septic tanks into water supplies has led the Maryland 
Water Pollution Control Commission to adopt rigid 
regulations to prevent laundries and car-washing busi- 
nesses from flushing untreated detergents into streams 
and septic tanks. — Public Health Reports 78(11): 954, 
November 1963. 



800 PER CENT INCREASE IN LUNG CANCER DEATHS 

Lung cancer has had the greatest rise — more than 
800 per cent — in mortality of any non-infectious disease 
in the United States over the last 30 years. The cause 
is generally attributed to the increase in cigarette smok- 
ing. At the same time, the American Cancer Society 
points out, deaths from stomach cancer have shown a 
sharp, dramatic drop. The cause is unknown. 



24 



U.S. NAVY MEDICAL NEWS LETTER 



POSTGRADUATE SHORT COURSES FOR MEDICAL DEPARTMENT OFFICERS 
SPONSORED BY THE DEPARTMENT OF THE ARMY DURING FY 1965 

Notice: The attention of readers is invited to a previous listing of postgraduate short 
courses for Medical Department Officers sponsored by the Department of the Army 
for the first half of fiscal year 1965 which was published in the U.S. Navy Medical 
News Letter, Vol. 43, No. 11, Page 17 of 5 June 1964. 

The following postgraduate professional short courses will be conducted by the Army Medical Service during 
Fiscal Year 1965. Officers desiring to attend should submit their requests in ample time to reach the Bureau 
at least 8 weeks prior to the convening date of the course desired. This lead time is necessary in order to 
comply with the Army's request to return unused quotas 6 weeks in advance of the convening dates of the 
courses listed. 

COURSES INSTALLATION DATE 

Neuropathology Armed Forces Institute of Pathology 1-5 Feb 1965 MC 

Annual Armed Forces Institute of Pathology Armed Forces Institute of Pathology 15-19 Feb 1965 MC 

Lectures — 1 965 
Pathology of the Oral Regions Armed Forces Institute of Pathology 1-5 Mar 1965 DC, MC 

Electron Microscopy Armed Forces Institute of Pathology 15-19 Mar 1965 DC, MC, MSC 

Geographic Pathology of Microbiologic Armed Forces Institute of Pathology 5-9 Apr 1965 MC, MSC 

Diseases 
Walter Reed General Hospital Otolaryngol- Armed Forces Institute of Pathology 3 May-25 Jun 1965 MC 

ogy Basic Science Course 
Surgical and Orthopaedic Aspects of Brooke General Hospital 8-12 Mar 1965 DC, MC 

Trauma 

Oral Surgery Letterman General Hospital 5-9 Apr 1965 DC 

Advanced Medical Operations in Modern Medical Field Service School, 1 Mar-2 Apr 1965 All Corps 
Warfare Brooke Army Medical Center 

Advanced Military Nursing Medical Field Service School, 8-19 Mar 1965 NC 

Brooke Army Medical Center 

Advanced Pathology of the Oral Regions U.S. Army Institute of Dental Re- 8-12 Mar 1965 DC, MC 

search, Walter Reed Army Med- 
ical Center 

Oral Diagnosis and Therapeutics U.S. Army Institute of Dental Re- 3-7 May 1965 DC 

search, Walter Reed Army Med- 
ical Center 

Principles of Military Dental Research U.S. Army Institute of Dental Re- 10-14 May 1965 DC, MSC 

search, Walter Reed Army Med- 
ical Center 

Tri-Service Pediatric Seminar Walter Reed General Hospital 3-5 Mar 1965 MC 

Symposium on Current Surgical Practices Walter Reed General Hospital 12-14 Apr 1965 MC 

Surgical Nursing Walter Reed Army Institute of Re- 8-12 Mar 1965 NC 

search 

Preventive Medicine and Laboratory Officer Walter Reed Army Institute of Re- 29 Mar-2 Apr 1965 MC, MSC 
Symposium search 

Maternal and Child Health Nursing William Beaumont General Hospital 5-9 Apr 1965 NC 

Notice: Army PG Course "Introduction to Research Methods", scheduled to be conducted at the AFIP 2-6 
November 1964, has been cancelled.— Training Branch, Professional Div., BuMed 

U.S. NAVY MEDICAL NEWS LETTER 25 



IMPORTANT NOTICE 

OFFICER PREFERENCE AND PERSONAL 
INFORMATION CARD 



The attention of all officers of the Medical Depart- 
ment is invited to SUPERS Instruction 1301. 25B. This 
reference sets forth detailed instructions regarding sub- 
mission of the new Officer Preference and Personal 
Information Card, NAVPERS 2774 (Rev. 5-62), 

It appears that many officers neglect to submit these 
cards because they feel they are not used. It is pointed 
out that after being processed through the Bureau of 
Naval Personnel, preference cards are forwarded to 
the Bureau of Medicine and Surgery to become part of 
each officer's record. These cards are constantly 
utilized in making assignments and their importance 
cannot be emphasized too strongly. They should be 
submitted annually or when significant changes occur. 
The items that receive particular attention in this Bu- 
reau are duty preferences, dependency status, ages of 
dependents, current residence, and any comments con- 
tained in Item 24 (Remarks). Careful attention should 
be given to the completion of Section 20 (Next Duty 
Preferences). The block beneath sea, overseas, and 
shore should be filled in to indicate which type of duty 
is first, second, or third choice. Nurse Corps officers 
are requested to completely fill out Item 16 (Dependent 
Members of Household) when applicable, and to note in 
Item 24 (Remarks) whether or not dependents are living 
and moving with them. 

Officers who consistently indicate preference for a 
specific geographic area, with little or no consideration 
given to the type activity and/ or primary billet, may 
penalize themselves professionally. The officer who is 



enamored with one Coast, or who prefers "any billet" 
so long as he gets a particular area, should be aware 
that his assignment may be inconsistent with the en- 
hancement of his professional qualifications and illogical 
in consequence of his prior training and experience. 
In proposing officers for changes of duty, needs of the 
service are balanced carefully against career require- 
ments and personal preferences. The officer who shows 
willingness to subordinate professional qualification to 
an area choice takes an extremely shortsighted view of 
his career. 

This Bureau commends and wishes to assist officers 
who aspire to attainment of further education. To this 
end, whenever preferences are based on the desire for 
assignment near a civilian university in order to earn 
credits in part-time educational programs, every con- 
sideration consistent with service needs will be given. 

Although Officer Preference and Personal Informa- 
tion Cards should normally be submitted annually on 
1 March, a submission is welcome at any time an officer 
desires to indicate a change in his duly preference(s) 
or when some other factor arises which he desires to 
report for consideration. 

It is recommended that all Medical Department offi- 
cers review their service records to determine whether 
they contain a copy of the current preference card as 
required by BUPERS Manual Art. B-2207(4) (b). If 
not, officers should submit a current card immediately. 

— Medical Corps Branch, Professional Division, 
BuMed. 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER- HTP if T"r.unTn«T .^ 

BETHESDA. MARYLAND 200T4^^;?J^-^^ TECHNICAL LIBRARY 

aADIGAN ARMY K03PITAL 

OFFICI AL BU SINESS ThCQMA, WASHINGTON 



POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



L XO-9 



PERMIT NO. I048 



^i?r^r^-5!^53J^ 






26 



U.S. NAVY MEDICAL NEWS LETTER